A nurse-delivered analgesia pathway for severe pain reduction during radial access

Background and Objectives Radial arterial cannulation is routinely performed in cardiac catheterisation units and may cause significant pain during subcutaneous local anaesthetic infiltration and arterial sheath insertion. There is currently no standardised protocol for topical analgesia prior to lidocaine infiltration. We evaluated the clinical effectiveness and workflow impact of two topical analgesic strategies compared with no pretreatment, with particular attention to the prevention of severe pain (VAS ≥6). Methods This was a prospective, observational, non-randomised study including 215 consecutive patients sequentially allocated to a control group (n=70), topical analgesic cream (n=71), or cold spray (n=74). Pain was assessed using a 0–10 visual analogue scale during local anaesthetic infiltration (time point 1) and after arterial sheath insertion (time point 2). Multivariable linear regression analysis was performed, adjusting for age, sex, hypertension, diabetes, dyslipidaemia and smoking status. No significant baseline differences were observed between the groups. Results At time point 1, mean VAS was 4.37±2.0 in controls, 3.61±1.7 with cream and 3.12±1.5 with cold spray (overall p<0.001). Compared with control, pain was reduced by 0.76 points with cream (p=0.017) and by 1.25 points with cold spray (p<0.001), with no significant difference between active treatments (p=0.069). At time point 2, mean VAS was 3.54±2.3 in controls, 2.41±2.2 with cream and 2.71±2.0 with cold spray (overall p=0.011). Pain reduction versus control was 1.13 points with cream (p=0.006) and 0.83 points with cold spray (p=0.032), without significant differences between active treatments (p=0.431). Severe pain (VAS ≥6) occurred in 24.3% of controls, 9.9% with cream, and 5.4% with cold spray, corresponding to an absolute reduction of 18.9% versus control. Preparation time differed markedly: 97.9±59.8 minutes for cream versus 11.5±4.1 minutes for cold spray (p<0.001). Cost per patient was €0.25 for cream compared with €0.08 for cold spray Conclusions A structured nurse-delivered topical analgesia pathway is associated with clinically meaningful reductions in pain during radial access. Cold spray provides the largest adjusted reduction at infiltration, substantially lowers the incidence of severe pain, and offers important workflow advantages, supporting its implementation in high-volume catheterisation laboratories.