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.
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引用次数: 0
Abstract
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 conducted between September 2021 and December 2023. With written consent, 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-gauge needle. The primary outcome was access site pain measured by visual analog scale (VAS) at predetermined three points. Secondary outcomes included drug-related costs.
Results: VAS scores at all three 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.
目的：经桡骨远端（TDRA）和经桡骨动脉（TRA）置管的最佳局麻药尚不明确且不规范。本研究比较了在标准利多卡因皮下注射的基础上添加利多卡因贴片用于TDRA和TRA手术的疗效和成本效益。方法：这是一项前瞻性单盲研究，于2021年9月至2023年12月进行。经书面同意，缺血性心脏和外周动脉疾病患者连续接受TDRA或TRA置管的患者被随机分配，在手术前至少30分钟在计划的动脉通道部位接受利多卡因贴片（利多卡因组，n=41）或安慰剂贴片（安慰剂组，n=43），随后使用27号针头进行利多卡因皮下麻醉。主要结局是通过视觉模拟量表（VAS）在预定的三个点测量接入处疼痛。次要结局包括药物相关费用。结果：三个点的VAS评分具有可比性(利多卡因与安慰剂：利多卡因输注20 mm vs 19 mm， P=0.55；手术过程中17 mm vs 14 mm， P=0.67；术后9 mm vs 12 mm， P=0.71)。即使只考虑利多卡因贴片，利多卡因组的成本也明显更高（0.43美元vs. 0.00美元）。讨论：在标准利多卡因皮下注射中添加利多卡因贴片用于TDRA或TRA置管并没有改善疼痛缓解或成本效益。
期刊介绍：
The Clinical Journal of Pain explores all aspects of pain and its effective treatment, bringing readers the insights of leading anesthesiologists, surgeons, internists, neurologists, orthopedists, psychiatrists and psychologists, clinical pharmacologists, and rehabilitation medicine specialists. This peer-reviewed journal presents timely and thought-provoking articles on clinical dilemmas in pain management; valuable diagnostic procedures; promising new pharmacological, surgical, and other therapeutic modalities; psychosocial dimensions of pain; and ethical issues of concern to all medical professionals. The journal also publishes Special Topic issues on subjects of particular relevance to the practice of pain medicine.
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