Qureshi Adnan I, Saleem Muhammad A, Naseem Nishath, Aytac Emrah, Akpinar Cetin Kursad, Wallery Shawn S
Zeenat Qureshi Stroke Institute, St Cloud MN, University of Illinois and Mercyhealth, Rockford, IL, USA.
Mercyhealth, Janesville, WI, USA.
J Vasc Interv Neurol. 2018 Jun;10(1):60-64.
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.
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).
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 ( = 31), 2 ( = 61), 3 ( = 48), and 4 ( = 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.
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.
测试外用复方利多卡因乳膏（2.5%利多卡因和2.5%丙胺卡因）在成年患者神经血管内介入手术的股动脉插管过程中控制疼痛的有效性。
将覆盖股动脉搏动处的身体体型分为：（1）可见耻骨联合和髂嵴骨突出；（2）未见耻骨联合和髂嵴骨突出但易于触及；（3）耻骨联合和髂嵴骨突出难以触及；（4）腹部各层覆盖在股部区域。使用数字评分量表对股动脉插管时的疼痛严重程度进行分类，评分范围为0（无疼痛）至10（最剧烈疼痛）。主要终点是疼痛控制良好（评分≤1）和疼痛控制失败（评分≥8）的患者比例。
纳入的186例患者的数字评分量表平均（±标准差）得分和中位数得分分别为2.4±2.7和1。疼痛控制良好的患者比例为49.4%[95%置信区间（CI）42.1%-56.7%]，疼痛控制失败的患者比例为6.9%（95%CI 4.1%-11.6%）。身体体型分级为1级（n = 31）、2级（n = 61）、3级（n = 48）和4级（n = 46）。多因素分析显示，4级身体体型[比值比（OR）1.8；95%CI 1.3-2.9]、4级插管难易程度（OR 2.1；95%CI 1.2-2.7）和既往股动脉插管史（OR 2.5；95%CI 1.8-4.2）是疼痛控制失败的独立预测因素。1级插管难易程度（OR 1.6；95%CI 1.2-3.1）独立预测疼痛控制良好。
尽管不利身体体型的发生率相对较高，但外用复方利多卡因乳膏作为局部利多卡因浸润的辅助用药，在股动脉插管过程中疼痛控制失败的发生率非常低。
