Pain associated with peripheral angiography: is lidocaine effective?

In a double-blind study, 28 patients for peripheral angiography received contrast injection both with and without lidocaine. In 22 patients not receiving premedication, the addition of lidocaine to the contrast medium resulted in increased pain in 54.5% of patients and no difference in pain in 41% when compared to contrast alone. In patients premedicated with 5--10 mg Valium intravenously, the addition of lidocaine to the contrast medium resulted in increased pain in half the patients and no difference in the others. The physiologic mechanisms are discussed, and the importance of hyperosmolality of contrast agents in pain production is stressed.