Usefulness of subcutaneous nitrate for radial access.
OBJECTIVE
We made the hypothesis that adjunction of nitrate to lidocaine for local anesthesia may facilitate accessibility of radial access.


BACKGROUND
Transradial approach is associated with a clear decrease in the rate of access bleeding when compared with femoral approach. The diffusion of this technique remains limited due to the small size and the spastic profile of this artery.


METHODS
Eighty-four consecutive patients undergoing coronary procedures using radial approach were randomly assigned between two types of local anesthesia (double blind): 5 ml lidocaine (group L)-5 ml lidocaine + 0.5 mg dinitrate isosorbide (group LN). The primary endpoint was the duration of radial puncture (from beginning of local anesthesia to sheath insertion) and the total number of punctures.


RESULTS
Sixty-two men and 22 women (mean age 59 +/- 8 y.o.) were included. Mean +/- SEM access duration was 3:33 +/- 3:11 min in group L when compared with 2:26 +/- 1:20 min in group LN (P < 0.05). Mean number of puncture was 1.50 +/- 1.0 in group L when compared with 1.16 +/- 0.5 in group LN (P = 0.05). There were no differences between two groups concerning pain score during anesthesia and sheath insertion. There was no difference between two groups concerning the rate of hypotensive and vagal reactions. Radial spasm occurred in four patients in group L and only one in the group LN.


CONCLUSIONS
Local anesthesia using lidocaine plus nitrate is feasible and improves the accessibility of radial access.
Ouadhour
Anissa
A
Coronary Care Unit, Department of Cardiology, Lariboisiere Hospital, Assistance publique-Hopitaux de Paris, Paris, France.
Sideris
Georgios
G
Coronary Care Unit, Department of Cardiology, Lariboisiere Hospital, Assistance publique-Hopitaux de Paris, Paris, France.
Smida
Walid
W
Coronary Care Unit, Department of Cardiology, Lariboisiere Hospital, Assistance publique-Hopitaux de Paris, Paris, France.
Logeart
Damien
D
Coronary Care Unit, Department of Cardiology, Lariboisiere Hospital, Assistance publique-Hopitaux de Paris, Paris, France.
Stratiev
Victor
V
Coronary Care Unit, Department of Cardiology, Lariboisiere Hospital, Assistance publique-Hopitaux de Paris, Paris, France.
Henry
Patrick
P
Coronary Care Unit, Department of Cardiology, Lariboisiere Hospital, Assistance publique-Hopitaux de Paris, Paris, France.
D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007548:Isosorbide Dinitrate / Q000008:administration & dosage*; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D011446:Prospective Studies; D011677:Punctures; D017534:Radial Artery / Q000187:drug effects* / Q000503:physiopathology; D013035:Spasm / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D014661:Vasoconstriction / Q000187:drug effects*; D014665:Vasodilator Agents / Q000008:administration & dosage*
D000779:Anesthetics, Local; D014665:Vasodilator Agents; D008012:Lidocaine; D007548:Isosorbide Dinitrate