Objectives: To test the effectiveness of EMLA cream (lidocaine 2.5% and prilocaine 2.5%) for pain control during femoral artery catheterization for diagnostic and interventional neurovascular procedures in awake patients.
Methods: Topical EMLA cream was applied in the femoral region under occlusive dressing prior to lidocaine infiltration and femoral artery catheterization. The body habitus overflying the femoral arterial pulsation was graded as: (1) Pubic symphysis and iliac crest bone protuberance visualized; (2) Pubic symphysis and iliac crest bone protuberances not seen but easily palpable; (3) Pubic symphysis and iliac crest bone protuberance palpable with considerable difficulty; (4) Abdominal layers fold over the femoral region. The severity of pain at femoral artery catheterization was classified using a visual analog scale (VAS) rating from 0-10. Ease of cannulation was scored using a four-point scale, ranging from insertion at first attempt (1), a number of minor adjustments needed (2), a second attempt required (3), or failure of 2 or more attempts (4). The primary endpoints were the proportion of patients with good (VAS score of <3) and excellent (VAS score of ≤1) pain control, and failed pain control (VAS score of ≥8).
Results: A total of 164 patients (mean age ±SD, 60.8±16.1) were included in the registry. The mean (±SD) and median VAS scores were 2.2±2.6 and 1, respectively. The ease of cannulation was rated as 1 (n=49), 2 (n=82), 3 (n=20, and 4 (n=13). The proportions of patients with good, excellent, and failed pain control were 69.4%, 51.5%, and 4.4%, respectively. The primary endpoints were significantly different according to strata defined by body habitus as follows (Table 1):
Conclusions: Topical EMLA cream as an adjunct to local lidocaine infiltration was associated with high rates of good and excellent pain control during femoral artery catheterization in this cohort of patients despite a relatively high rate of unfavorable body habitus.