Effectiveness of Topical Lidocaine-Prilocaine Cream for Pain Control During Femoral Artery Catheterization in Adult Patients: a Prospective Study

Abstract

Objective—To test the effectiveness of topical EMLA cream (lidocaine 2.5% and prilocaine 2.5%) for
pain control during femoral artery catheterization for neuro-endovascular procedures in adult patients.
Methods—The body habitus overlying the femoral arterial pulsation was graded as: (1) pubic symphysis
and iliac crest bone protuberances visualized; (2) Pubic Symphysis and Iliac Crest bone protuberances not
seen but easily palpable; (3) Pubic Symphysis and Iliac Crest bone protuberances palpable with considerable difficulty; and (4) abdominal layers fold over the femoral region. The severity of pain at femoral artery
catheterization was classified using a numeric rating scale score ranging from 0 (no pain) to 10 (worst
pain). The primary endpoints were the proportion of patients with excellent (score of ≤1) and failed pain
control (score of ≥8).
Results—The mean (±SD) and median numeric rating scale scores were 2.4 ± 2.7 and 1, respectively, in
186 patients included. The proportion of patients with excellent pain control was 49.4% [95% confidence
interval (CI) 42.1%–56.7%] and failed pain control was 6.9% (95% CI 4.1%–11.6%). The body habitus
was graded as 1 (n = 31), 2 (n = 61), 3 (n = 48), and 4 (n = 46). In multivariate analysis, grade 4 body
habitus [odds ratio (OR) 1.8; 95% CI 1.3–2.9], grade 4 ease of cannulation (OR 2.1; 95% CI 1.2–2.7), and
previous femoral artery catheterization (OR 2.5; 95% CI 1.8–4.2) were independent predictors of failed
pain control. Grade 1 ease of cannulation (OR 1.6; 95% CI 1.2–3.1) independently predicted excellent pain
control.
Conclusion—Topical EMLA cream as an adjunct to local lidocaine infiltration was associated with very
low rates of failed pain control during femoral artery catheterization despite a relatively high rate of unfavorable body habitus