Effect of Intravenous Fentanyl to Prevent Radial Artery Spasm During Trans Radial Intervention

University Heart Journal Pub Date : 2022-01-31 DOI:10.3329/uhj.v18i1.57881

Partha Pratim Saha, A. Choudhury, S. Ahsan, A. Momen, S. R. Patwary, N. Alam, Kofil Uddin, Pritha Sarkar, Heru Al Amin

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Abstract

Background: Radial artery spasm (RAS), one of the commonest complications in trans radial cardiac intervention, leads a variety range of adverse events. Different prevention strategies had been introduced and the use of sedation is one of them. Use of Fentanyl is common in cardiac interventions to achieve sedation and analgesia and also offers a potent vasodilatory effect. Objective: This study aimed to explore the role of fentanyl in the prevention of RAS in trans radial intervention. Methods: This observational analytic study was conducted in National Institute of Cardiovascular Diseases (NICVD) for a period of 1 year following approval of the protocol in the total of 260 patients who underwent coronary intervention through trans radial approach (Coronary Angiogram and or Percutaneous Coronary Intervention). They were categorized in 2 group- group I patients received intravenous fentanyl and group II patients didn’t receive fentanyl. Besides this, each patient received all treatments according to standard protocol of NICVD. RAS was identified by subjective and objective evidence. Patient is discomfort was quantified with a visual analogue scale. Results: The frequency of RAS was 17.70% in group I versus 30.80% in group II (p =0.014). Intravenous use of fentanyl significantly reduced radial artery spasm (p< 0.05). Bivariate logistic regression analysis showed use of fentanyl had lower odds to prevent radial artery spasm (odds ratio [OR]: 0.430, 95% confidence interval [CI]: 0.239 to 0.779). The number needed to treat to avoid 1 case of spasm was 8. Multivariate logistic regression analysis also revealed use of fentanyl was the strong predictor of RAS ([OR]: 0.370; 95% [CI]: .195-.703) as well as use of reprocessed sheath, smoking, catheter diameter 6Fr and visual analogue scale (VAS) Score during cannulation became independent predictaor of RAS. Patient discomfort in VAS score was 4.75±2.70 in Group I versus 5.33±2.64 in group II (p< 0 .05). Conclusion: In this study, use of fentanyl reduced the frequency of radial artery spasm and the procedure related level of patient discomfort. University Heart Journal 2022; 18(1): 54-60

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静脉注射芬太尼预防桡动脉介入治疗中桡动脉痉挛的作用

背景:桡动脉痉挛(RAS)是经桡动脉心脏介入治疗中最常见的并发症之一，可导致一系列不良事件。采用了不同的预防策略，镇静的使用是其中之一。使用芬太尼是常见的心脏干预，以实现镇静和镇痛，也提供了一个有效的血管扩张作用。目的:探讨芬太尼在经桡动脉介入治疗中预防RAS的作用。方法:这项观察性分析研究是在国家心血管疾病研究所(NICVD)进行的，为期1年，共260例通过经桡动脉入路(冠状动脉造影和/或经皮冠状动脉介入治疗)进行冠状动脉介入治疗的患者。将患者分为两组，第一组患者静脉注射芬太尼，第二组患者不注射芬太尼。除此之外，每位患者均按照NICVD的标准方案接受了所有治疗。通过主客观证据对RAS进行鉴定。用视觉模拟量表量化患者的不适程度。结果:RAS发生率I组为17.70%，II组为30.80% (p =0.014)。静脉注射芬太尼可显著减少桡动脉痉挛(p< 0.05)。双变量logistic回归分析显示，使用芬太尼预防桡动脉痉挛的几率较低(优势比[OR]: 0.430, 95%可信区间[CI]: 0.239 ~ 0.779)。避免1例痉挛需要治疗的次数为8次。多因素logistic回归分析也显示芬太尼的使用是RAS的强预测因子([OR]: 0.370;95% [CI]: 0.195 ~ 0.703)、使用再处理护套、吸烟、插管时导管直径6Fr和视觉模拟评分(VAS)评分成为RAS的独立预测指标。患者VAS不适评分I组为4.75±2.70分，II组为5.33±2.64分(p< 0.05)。结论:在本研究中，芬太尼的使用减少了桡动脉痉挛的频率和手术相关的患者不适程度。大学心脏杂志2022;18 (1): 54-60

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University Heart Journal

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