Reducing Pain, Spasm, and Vasovagal Syndrome in Transradial Cardiac Angiography: The Role of Lidocaine Cream and Injectable Lidocaine

Abstract

Background: Transradial cardiac angiography offers advantages in therapeutic outcomes and economic efficiency; however, it is associated with side effects such as pain, vascular spasm, and vasovagal syndrome. Objectives: This study evaluates the efficacy of injectable lidocaine, with and without the application of topical lidocaine cream, in mitigating these adverse effects. Methods: In this single-blinded clinical trial, 80 patients aged 18 and older who referred to Shahid Modarres Hospital, Tehran, Iran, between 2022 and 2023 were enrolled. Participants met specific criteria to ensure a homogeneous study population. They were randomly assigned to receive either lidocaine cream in conjunction with a subcutaneous lidocaine injection or a placebo cream with subcutaneous lidocaine. Pain intensity was assessed using the Visual Analog Scale (VAS), and complications were recorded through pre-designed checklists. Statistical analyses were performed using SPSS version 23, employing appropriate tests to explore significant differences. Results: The mean age of participants was 58.1 years, with both groups exhibiting similar demographic characteristics. Statistical analysis indicated that the use of lidocaine cream significantly reduced pain occurrence, with none in the experimental group reporting pain compared to 7 in the control group (P = 0.006). Furthermore, lidocaine cream decreased the incidence of spasms, noted in 5 patients in the control group, with no spasms reported in the experimental group (P = 0.021). Additionally, vasovagal syndrome was significantly lower in the experimental group (P = 0.011). Conclusions: The study indicates that pre-application of lidocaine cream prior to injectable lidocaine effectively alleviates pain, vascular spasm, and vasovagal syndrome in patients undergoing transradial cardiac angiography, supporting its incorporation into routine practice to enhance patient comfort and safety.