Topical Lidocaine-Prilocaine Cream (EMLA[registered sign]) Versus Local Infiltration Anesthesia for Radial Artery Cannulation

In a randomized trial, we compared topical anesthesia by a lidocaine-prilocaine cream (EMLA[registered sign]; Laboratorie ASTRA, Manterre, France) with subcutaneous local lidocaine infiltration for radial artery cannulation. Patients included 538 adults scheduled for coronary angiography using a radial approach. EMLA[registered sign] was applied 2 h before radial cannulation, and lidocaine infiltration was performed 5 min before cannulation. The primary end point was pain as assessed by a verbal numerical scale (0 = no pain, 10 = extreme pain). Pain was less severe in the EMLA[registered sign] group than in the lidocaine infiltration group (Score of 2 vs 7; P = 0.0001). Additional lidocaine infiltration was required significantly less frequently in the EMLA[registered sign] group (relative risk 0.19). The failure rate of cannulation was significantly lower in the EMLA[registered sign] group (relative risk 0.38), and insertion time was shorter (4 versus 6 min). We conclude that EMLA[registered sign], compared with lidocaine infiltration, reduces pain associated with radial artery cannulation and improves the success rate of the procedure. Routine application of EMLA[registered sign] should be performed in awake patients 2 h before radial artery cannulation. Implications: In a randomized trial, we compared topical anesthesia by a lidocaine-prilocaine cream (EMLA[registered sign]) with subcutaneous local lidocaine infiltration for radial artery cannulation in 538 adults patients. EMLA[registered sign] reduced pain associated with radial artery cannulation and improved the success rate of the procedure. (Anesth Analg 1998;87:403-6)