Intra-arterial lidocaine versus saline to reduce peri-procedural discomfort in patients undergoing percutaneous trans-radial or trans-ulnar coronary procedures

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 intra-arterial lidocaine versus saline to reduce pen-procedural discomfort during percutaneous trans-radial or trans-ulnar procedures. Methods and 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 1 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.