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Regional intracoronary analgesia during percutaneous transluminal coronary angioplasty
Thomas Aversano1, Gary D Walford, Mark Midei
1Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD 21205 USA.
Insights
Intracoronary lidocaine effectively reduced pain during coronary angioplasty by delaying pain onset and decreasing its severity. This intervention proved safe for patients with normal heart function undergoing elective procedures.
Area of Science:
- Cardiology
- Pain Management
- Pharmacology
Background:
- Ischemic pain during coronary angioplasty limits procedure duration and patient comfort.
- Percutaneous transluminal intravascular interventions require effective pain management strategies.
Purpose of the Study:
- To evaluate the efficacy of intracoronary lidocaine in reducing angioplasty-induced ischemic pain.
- To assess the safety and impact of intracoronary lidocaine on hemodynamics and electrophysiology.
Main Methods:
- Sixteen patients undergoing elective coronary angioplasty received intracoronary lidocaine or placebo before balloon inflations.
- Pain was assessed using an ordinal scale during occlusions.
- Hemodynamic and electrophysiologic parameters were monitored.
Main Results:
- Lidocaine significantly delayed pain onset (48 +/- 7 sec vs. 23 +/- 4 sec) and reduced pain magnitude (7.8 +/- 1.3 vs. 3.2 +/- 1.3).
- No significant adverse hemodynamic or electrophysiologic effects were observed in most patients.
- Transient atrioventricular conduction delay occurred when lidocaine targeted the atrioventricular node artery.
Conclusions:
- Intracoronary lidocaine is a safe and effective analgesic for managing ischemic pain during elective coronary angioplasty in patients with normal ventricular function.
- Lidocaine offers a promising option for improving patient comfort and potentially extending intervention times.
Abstract:
The ischemic pain associated with balloon inflation during coronary angioplasty remains a significant source of procedural discomfort and sets a limit on the duration of percutaneous transluminal intravascular interventions. The present study examined whether intracoronary lidocaine reduced the pain of coronary angioplasty. Sixteen patients undergoing elective coronary angioplasty underwent three 90 sec balloon inflations: the first with administration of no intracoronary agent, and the second and third with administration of one or the other of placebo or an equal volume of lidocaine (10-16 mg). Placebo or lidocaine were randomized in administration sequence and were given just before balloon inflation. During the occlusions, pain was scored on an ordinal scale (0 = no pain; 10 = most severe pain). Lidocaine delayed the onset of pain (23 +/- 4 vs. 48 +/- 7 sec, P < 0.005) and reduced its magnitude (at end-inflation: 7.8 +/- 1.3 vs. 3.2 +/- 1.3, P < 0.01). There were no significant hemodynamic or electrophysiologic effects in this group of patients, although atrioventricular conduction was delayed when lidocaine was administered into the epicardial coronary which had the atrioventricular node artery as a branch. Intracoronary analgesia with lidocaine is safe and effective in a select group of patients with normal ventricular function undergoing elective coronary angioplasty.