Enhanced Pain Management With Combined EMLA Patch and Local Anesthetic Infiltration in Transradial Angiography

Clin Cardiol. 2026 Aug;49(8):e70444. doi: 10.1002/clc.70444.

ABSTRACT

BACKGROUND/OBJECTIVES: Pain at the radial access site remains common during coronary angiography. Evidence on topical anesthesia with EMLA patches is inconsistent, and the added value of combining EMLA with local lidocaine infiltration has not been fully clarified. This study compared the analgesic effectiveness of three strategies: EMLA patch, local lidocaine infiltration, and their combination.

METHODS: In this retrospective study, 275 patients undergoing elective transradial coronary angiography received either EMLA patch (n = 88), local infiltration (n = 96), or combined EMLA + infiltration (n = 91). Inclusion required the availability of complete data on pain assessments and access-site complications. Pain intensity during the procedure and over 24 h was assessed using the Numeric Pain Rating Scale at five time points. Group comparisons used the Mann-Whitney U, Kruskal-Wallis, one-way ANOVA, or chi-square test. Linear regression was applied to identify predictors of pain.

RESULTS: Pain during angiography was lowest with combined anesthesia (median 0 [0-1]), compared with EMLA (1 [0-2]) or infiltration (3 [1-5]) (p < 0.001). Similar findings were observed for the 24 h cumulative pain score. An EMLA application time of 100-300 min was associated with substantially lower pain than shorter or longer durations (both p < 0.001). Obesity (BMI ≥ 30 kg/m²) independently predicted higher procedural pain (B = 0.96; p = 0.020) and higher 24 h cumulative pain (B = 2.70; p = 0.002).

CONCLUSIONS: Combined EMLA patch plus local lidocaine infiltration was associated with superior analgesia during and after transradial coronary angiography compared with either method alone. An EMLA application time of 100-300 min may optimize analgesic effectiveness, while patients with obesity may benefit from tailored pain-management strategies.

PMID:42635295 | DOI:10.1002/clc.70444