Topical lidocaine effectively mitigates radial pain, spasm, and sympathetic response following trans-radial coronary angiography: A randomized, double-blind, placebo-controlled clinical trial.

Radial artery spasm (RAS) remains the most prevalent complication of trans-radial coronary angiography (TRA). Therefore, we aimed to evaluate the impacts of topical lidocaine on radial pain, spasm, and sympathetic response among patients undergoing TRA. We performed a randomized, double-blind, placebo-controlled trial involving 276 eligible patients for TRA. The patients were 1:1 randomized to receive topical lidocaine gel (2%, 1 g applied to the wrist) or placebo gel 30 min before the angiographic procedure. The incidence of angiographically and clinically diagnosed RAS was recorded, and radial pain was assessed using a visual analogue scale (VAS). Sympathetic responses, including systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR), were also measured. The median of the self-reported and physician-reported VAS was notably lower in the lidocaine group [1.0 (2.0) and 2.0 (2.0)] than in the placebo group [5.0 (4.0) and 6.0 (3.0)] during sheath insertion (P < 0.001). Interestingly, the SBP (P < 0.001) and HR (P = 0.044) were meaningfully blunted in the lidocaine group than the placebo group after the angiographic procedure. Moreover, lidocaine application provided a significant decrease in the incidence of angiographic RAS (14.3% and 48.2%), clinical RAS (16.5% and 67.2%), forearm discomfort when using catheter sheath (16.5% and 65.7%), difficulty in catheter manipulation (15.8% and 56.2%), difficulty in removing catheter (15.8% and 51.8%), and need for vasodilator injection to relieve spasm (8.6% and 48.2%) comparing to the placebo group (P < 0.001 for all). The lidocaine gel application significantly decreased radial pain score, angiographic and clinical RAS incidence, and sympathetic response in patients undergoing TRA.