| ObjectivesTo compare the anesthetic effects of external application of compound lidocaine cream and local infiltration anesthesia of lidocaine during coronary intervention through the Transradial artery access(TRA),and to verify the clinical application value of external application of compound lidocaine cream.MethodsA total of 180 patients who underwent coronary intervention through radial artery in the Department of Cardiology,Central Hospital Affiliated to Shenyang Medical College from June 2021 to August 2022 were collected.According to the method of random number table,the patients were divided into infiltration group(lidocaine local infiltration anesthesia),30 min external application group(compound lidocaine cream external anesthesia 30min)and 60 min external application group(compound lidocaine cream external anesthesia 60min),with 60 cases in each group.All patients were pre-cleaned puncture site of the right radial artery and the surrounding skin with 75% alcohol before surgery,and the external application range was marked along the puncture site(range: the puncture site was 3cm centered on the horizontal axis;The longitudinal axis is 1cm distal to the puncture point,9cm proximal to the puncture point).In the infiltrating group,placebo(ultrasonic coupling agent)was applied before the marked range,with a thickness of 1cm and a dose of2.5g/10cm2.After application,it was covered with plastic wrap for 30 min,followed by routine disinfection with iodophor.The puncture site was subjected to local infiltration anesthesia of 0.5ml 1% lidocaine injection,and then puncture was performed.In the 30 min and 60 min external application groups,compound lidocaine cream was applied within the marked range,with a coating thickness of 1cm and a dose of 2.5g/10cm2.After application,it was covered with plastic wrap for 30 min and60min,respectively,and then subjected to routine disinfection with iodopor,and then puncture was performed.Of three groups of patients who when the Radial artery puncture,as it is pulled into the sheath pipe process,sheath,2 hours to the postoperative pain digital pain score method is adopted to improve the score,by color doppler ultrasound measurement of Radial artery diameter(Radial artery diameter,RAD)and Peak systolic velocity(PSV),the change values of radial artery diameter and peak systolic blood flow in the three groups were compared before and 3days after surgery,and one-time puncture success rate,puncture time and incidence of postoperative puncture related complications were recorded in the three groups.Results1.Follow-up informationInfiltration group: 60 cases were enrolled,0 cases were lost to follow-up,and 0cases withdrew from the study.In the 30 min external application group:60 cases were selected,0 cases were lost to follow-up,and 0 cases withdrew from the subject.In the 60 min external application group: 60 cases were selected,0 cases were lost to follow-up,and 0 cases withdrew from the subject.2.Comparison of baseline data among the three groupsThere were no significant differences in clinical baseline characteristics of age,gender,BMI,history of coronary interventional surgery,hypertension,diabetes,preoperative radial artery diameter,preoperative systolic blood flow peak,preoperative venous indwelling needle pain score among three groups before treatment(P > 0.05).3.Comparison of anesthetic and analgesic effects during coronary intervention radial artery puncture among the three groupsPain scores of the three groups at the puncture site during radial artery puncture,during the process of entering the sheath canal,when the sheath was pulled out,and 2hours after surgery were respectively:The infiltrating group(1.64±0.40 min,4.00±0.55 min,3.30±0.68 min,0.81±0.41 min),the external application group(1.27±0.49 min,3.28 ± 0.66 min,2.43 ± 0.79 min,0.49 ± 0.32 min)and the external application group(1.26±0.52 min,3.20±0.61 min,2.47±0.72 min,0.46±0.29min).Compared among the three groups,the pain scores of the 30 min external application group and the 60 min external application group were similar in the intraoperative radial artery puncture,during the process of entering the sheath canal,when the sheath was pulled out,and 2 hours after the operation(P > 0.05).The pain scores of the two groups at the above time points were significantly lower than those of the infiltrating group(P < 0.01).4.Comparison of radial artery diameter and systolic blood flow peak at puncture point between the three groups before and 3 days after surgery(1)Comparison of the change of radial artery puncture site diameter between the three groups before surgery and the third day after surgeryThe change values of the radial artery puncture site internal diameter of patients in the three groups before and after surgery(ΔRAD= before RAD-on the third day after RAD)were positive,that is,the radial artery internal diameter of patients in the three groups after surgery was reduced compared with that before surgery,as follows:The infiltrating group(0.69±0.17mm),the external application group(0.55±0.13mm)for 30 minutes,and the external application group(0.53±0.14mm)for 60 minutes.Compared among the three groups,the changes of radial artery puncture point diameter in the 30 min external application group and the 60 min external application group were similar before and 3 days after surgery(P > 0.05),and the changes of radial artery puncture point diameter in the two groups before and 3 days after surgery were lower than those in the infiltrating group(P < 0.01).(2)Comparison of peak systolic blood flow at the radial artery puncture site before surgery and on the third day after surgery in the three groupsThe change values of peak systolic blood flow at the radial artery puncture site before and 3 days after surgery(ΔPSV= 3 days after PSV-before PSV)were all positive,that is,the postoperative peak systolic blood flow of the three groups were increased compared with that before surgery,respectively:The infiltrating group(10.17±2.21mm/s),the external application group(7.56±2.17mm/s)for 30 minutes,and the external application group(7.60±2.13mm/s)for 60 minutes.Compared among the three groups,the changes of peak systolic blood flow at the radial artery puncture site before and on the 3rd day after surgery in the 30 min external application group and the 60 min external application group were lower than those in the infiltrating group(P < 0.01),and the changes of peak systolic blood flow at the radial artery puncture site before and on the 3rd day after surgery were similar in the two groups(P > 0.05).5.Comparison of surgery-related indexes among the three groups(1)Comparison of one-time puncture success rates among the three groupsThe success rates of one-time puncture in the three groups were as follows:infiltration group(91.67%),30 min external application group(98.33%)and 60 min external application group(96.67%),and there was no statistical significance among the three groups(P > 0.05).(2)Comparison of puncture time among the three groupsThe puncture time of patients in three groups was as follows: infiltration group(25.45±5.29s),external application group(22.88±5.81s)for 30 minutes,and external application group(21.96±5.67s)for 60 minutes.Compared among the three groups,the puncture time of 30 min external application group and 60 min external application group was close to each other(P >0.05),and the puncture time of both groups was less than that of the infiltrating group(P < 0.05).6.Comparison of postoperative puncture related complications among the three groupsThe incidence rates of postoperative puncture related complications in the three groups were as follows: infiltration group(1.67%),30 min external application group(3.33%),60 min external application group(1.67%),and there was no statistical significance among the three groups(P > 0.05).Conclusions1.In the process of transradial coronary intervention,compared with lidocaine local infiltration anesthesia,external application of compound lidocaine cream has better analgesic effect,and the effect of external application of 30 min is similar to that of external application of 60 min.2.In the process of transradial coronary intervention,compared with local infiltration anesthesia with lidocaine,external anesthesia with compound lidocaine cream has a better effect on reducing vascular damage in patients,and the effect of external application for 30 min is similar to that of external application for 60 min.3.In the process of transradial coronary intervention,compared with the local infiltration anesthesia of lidocaine,external anesthesia of compound lidocaine cream can significantly shorten the puncture time,and the puncture time of 30 min is similar to that of 60 min.4.In the course of transradial coronary intervention,there was no significant difference in one-time puncture success rate and postoperative puncture related complications between compound lidocaine cream external anesthesia and lidocaine local infiltration anesthesia. |
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