title: Intra-arterial lidocaine versus saline to reduce peri-procedural discomfort in patients undergoing percutaneous trans-radial or trans-ulnar coronary procedures.
abstract: OBJECTIVE
  Trans-radial and trans-ulnar access is increasingly used for percutaneous coronary procedures, but spasm or pain may limit comfort and compliance. Intra-arterial lidocaine administration could provide a local anaesthetic effect, but its risk-benefit ratio is unclear. We aimed to compare intraarterial lidocaine versus saline to reduce peri-procedural discomfort during percutaneous trans-radial or trans-ulnar procedures.
  
  
  RESULTS
  Patients undergoing percutaneous trans-radial or trans-ulnar coronary procedures were single-blinded randomly assigned to intra-arterial treatment with 20 mg lidocaine or saline. The primary end-point of the study was local pain, measured on a 10-point scale. A total of 101 patients were enrolled (50 allocated to lidocaine and 51 to saline). Trans-radial access was employed in 48 (96%) and 47 (92%), respectively, trans-ulnar access in 2 (4%) and 4 (8%), and coronary intervention was performed in 18(36%) and 11 (22%). Severity of local pain was equivalent in both groups (2.3 +/- 2.3 vs. 3.0 +/- 2.5, P= 0.167). Similar results for both groups were found also for local spasm, local access success, procedural success, and net clinical adverse events (all P > 0.05). No sustained cardiac arrhythmia or neurologic symptom developed in any patient.
  
  
  CONCLUSIONS
  Current approaches and techniques for percutaneous trans-radial or trans-ulnar coronary procedures are associated with few local or systemic complications. Local forearm/wrist pain is relatively frequent in this setting, and is not significantly prevented by intra-arterial lidocaine.
authors: Division of Cardiology, University of Turin, San Giovanni Battista Molinette Hospital, Turin, Italy. gbiondizoccai@gmail.com
authors: Giuseppe G L
authors: GG
authors: Biondi-Zoccai
authors: Claudio
authors: C
authors: Moretti
authors: Pierluigi
authors: P
authors: Omedè
authors: Filippo
authors: F
authors: Sciuto
authors: Pierfrancesco
authors: P
authors: Agostoni
authors: Enrico
authors: E
authors: Romagnoli
authors: Giuseppe
authors: G
authors: Sangiorgi
authors: Imad
authors: I
authors: Sheiban
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D006328:Cardiac Catheterization / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D017534:Radial Artery; D016037:Single-Blind Method; D017535:Ulnar Artery
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine