Usefulness of subcutaneous nitrate for radial access

We made the hypothesis that adjunction of nitrate to lidocaine for local anesthesia may facilitate accessibility of radial access.

Transradial approach is associated with a clear decrease in the rate of access bleeding when compared with femoral approach. The diffusion of this technique remains limited due to the small size and the spastic profile of this artery.

Eighty-four consecutive patients undergoing coronary procedures using radial approach were randomly assigned between two types of local anesthesia (double blind): 5 ml lidocaine (group L)-5 ml lidocaine + 0.5 mg dinitrate isosorbide (group LN). The primary endpoint was the duration of radial puncture (from beginning of local anesthesia to sheath insertion) and the total number of punctures.

Sixty-two men and 22 women (mean age 59 +/- 8 y.o.) were included. Mean +/- SEM access duration was 3:33 +/- 3:11 min in group L when compared with 2:26 +/- 1:20 min in group LN (P < 0.05). Mean number of puncture was 1.50 +/- 1.0 in group L when compared with 1.16 +/- 0.5 in group LN (P = 0.05). There were no differences between two groups concerning pain score during anesthesia and sheath insertion. There was no difference between two groups concerning the rate of hypotensive and vagal reactions. Radial spasm occurred in four patients in group L and only one in the group LN.

Local anesthesia using lidocaine plus nitrate is feasible and improves the accessibility of radial access.