The effect of a eutectic mixture of local anesthetic cream on wrist pain during transradial coronary procedures.
OBJECTIVE
We sought to evaluate the effects and optimal application time of a eutectic mixture of local anesthetic cream (EMLA-C) in relieving wrist pain during transradial coronary procedures (TRCP).


METHODS
The Phase I study enrolled 147 patients to evaluate the efficacy and safety of the EMLA-C during TRCP. The Phase II study was designed to evaluate the optimal preprocedure application time frame of EMLA-C for wrist pain reduction in 400 patients. The EMLA or placebo cream was applied at the puncture site from 2 to 4 hours before the procedure in Phase I, and randomized to 5 time groups according to the time of drug application in Phase II. We evaluated wrist pain by the visual analogue scale (VAS) or verbal rating scale (VRS-4), and evaluated complications as well.


RESULTS
EMLA-C demonstrated greater pain relief by VAS (control: 49+/-24, EMLA: 19+/-22; p = 0.001) and VRS-4 (control: 2.3+/-0.5, EMLA: 1.5+/-0.6; p = 0.001), and there was a negative correlation (r = -0.476; p = 0.001) between VAS and the preprocedure application time of EMLA-C. In Phase II, there was a significant difference in pain levels between the control and 1- to 2-hour groups by VAS (control: 49+/-29, EMLA1-2 hours: 32+/-24; p = 0.001) and VRS-4 (control: 2.4+/-0.6, EMLA1-2 hours: 1.9+/-0.6; p = 0.001). Drug-induced local erythema frequently occurred in the 3- to 4-hour group (6.6%) and >4 hours group (11.9%).


CONCLUSIONS
EMLA-C can be effective in reducing wrist pain during TRCP without any significant drug-related complications when the application time is 1 to 3 hours before the procedure.
Kim
Jang-Young
JY
Wonju College of Medicine, Yonsei University, Wonju, Kangwon Province, South Korea.
Yoon
Junghan
J
Yoo
Byung-Su
BS
Lee
Seung-Hwan
SH
Choe
Kyung-Hoon
KH
D000368:Aged; D000704:Analysis of Variance; D000772:Anesthesia, Local / Q000379:methods; D006328:Cardiac Catheterization / Q000379:methods; D016022:Case-Control Studies; D002406:Catheterization, Peripheral / Q000009:adverse effects; D017023:Coronary Angiography / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D008875:Middle Aged; D009824:Ointments; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011318:Prilocaine / Q000008:administration & dosage*; D011336:Probability; D017534:Radial Artery / Q000187:drug effects*; D012016:Reference Values
D004338:Drug Combinations; D000077442:Lidocaine, Prilocaine Drug Combination; D009824:Ointments; D011318:Prilocaine; D008012:Lidocaine