The effect of eutectic mixture of local anesthesia (EMLA) cream on sympathetic response and radial artery spasm during transradial coronary angiogram

Abstract

[한글]

[영문]Background and Objectives: Radial artery spasm (RAS) is one of the most common complications of the transradial angiography (TRA). Radial artery is prone to cathecholamine-induced contraction and the radial pain during procedure could increase the level of sympathetic response (SR). We evaluated the effect of eutectic mixture of local anesthesia (EMLA) cream on SR and RAS during TRA.Methods: Total 76 patients underwent TRA were enrolled. All patients were randomized to EMLA or control group according to the use of EMLA cream on wrist before TRA. Wrist pain was evaluated by the visual analogue scale (VAS) and verbal rating scale (VRS-4) during lidocaine infiltration and introducer sheath insertion. SR parameters including systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) were measured at baseline, after lidocaine infiltration, after puncture and after sheath insertion. RAS was determined by the pre-defined clinical findings and angiographic finding.Results: The baseline characteristics were not different between two groups. The wrist pain was lower in EMLA group during lidocaine infiltration (VAS: 3.1 ± 1.7 vs. 4.0 ± 1.7, p = 0.04; VRS-4: 2.0 ± 0.5 vs. 2.2 ± 0.5, p = 0.03, respectively). The SR was significantly blunted in EMLA group than placebo group from baseline to lidocaine infiltration (ΔSBP, mmHg: 5 ± 10 vs. 13 ± 12, p < 0.01; ΔDBP, mmHg: 2 ± 8 vs. 7 ± 12, p = 0.03; ΔMAP, mmHg: 3 ± 8 vs. 9 ± 10, p < 0.01; ΔPR, beat/min: 2 ± 4 vs. 8 ± 14, p < 0.01; ΔSV, ml: 3 ± 6 vs. 21 ± 17, p < 0.01; ΔCO, l/min: 0.2 ± 4.8 vs. 1.5 ± 1.4 p < 0.01 ΔTPR, mmHg?l/min; 1.0 ± 3.2 vs. 5.9 ± 8.2, p < 0.01, respectively). Although clinical or angiographic RAS was not different, minimal luminal diameter at the start of procedure was significantly larger in EMLA group (1.78 ± 0.54 mm vs. 1.51 ± 0.41 mm, p = 0.02). Conclusion: The EMLA cream could reduce the wrist pain and SR during lidocaine infiltration. In addition, benefit of EMLA cream on RAS at the start of the procedure is expected by larger minimal luminal diameter.