Comparing Combined Lidocaine Transdermal Patch and Lidocaine Subcutaneous Injection Versus Lidocaine Subcutaneous Injection Alone for Trans-distal Radial and Trans-radial Arterial Access Pain and Cost-Effectiveness: A Single-Blind Randomized Study.

OBJECTIVES

The optimal local anesthetic for trans-distal radial (TDRA) and trans-radial arterial (TRA) catheterization is unclear and not standardized. This study compared the efficacy and cost-effectiveness of adding a lidocaine patch to standard lidocaine subcutaneous lidocaine injection for TDRA and TRA procedures.

METHODS

This was a prospective, single-blind study. Consecutive patients undergoing TDRA or TRA catheterization in patients with ischemic heart and peripheral arterial disease were randomized to receive either a lidocaine patch (lidocaine group, n=41) or a placebo patch (placebo group, n=43) at the planned arterial access site at least 30 minutes before the procedure, followed by lidocaine subcutaneous anesthesia using a 27-G needle. The primary outcome was access site pain measured by visual analog scale (VAS) at predetermined 3 points (1) at the point of lidocaine subcutaneous injection (referred to as "before procedure" hereafter), (2) during the procedure ("during procedure"), (3) postprocedure until the confirmation of arterial hemostasis ("after procedure"). Secondary outcomes included drug-related costs.

RESULTS

VAS scores at all 3 points were comparable (lidocaine vs. placebo: at the point of lidocaine infusion 20 mm vs. 19 mm, P =0.55; during the procedure 17 mm vs. 14 mm, P =0.67; after the procedure 9 mm vs. 12 mm, P =0.71). The lidocaine group incurred significantly higher costs, even when considering only the lidocaine patch (0.43 USD vs. 0.00 USD, P <0.001) and the total amount of lidocaine patch and lidocaine subcutaneous infusion (0.62 USD vs. 0.21 USD, P <0.001).

DISCUSSION: The addition of a lidocaine patch to standard lidocaine subcutaneous injection for TDRA or TRA catheterization did not improve pain relief or cost-effectiveness.