Effectiveness of topical lidocaine-prilocaine cream for pain control during femoral artery catheterization in adult patients: A prospective study

Objective : To test the effectiveness of topical EMLA-cream (lidocaine 2.5% and prilocaine 2.5%) for pain control during femoral artery catheterization (FAC) for neuro-endovascular procedures in adult patients. Methods: The body habitus (BH) overlying the femoral arterial pulsation was graded as: (1) Pubic symphysis (PS) and iliac crest (IC) bone protuberance visualized; (2) PS and IC bone protuberances not seen but easily palpable; (3) PS and IC bone protuberance palpable with considerable difficulty; (4) Abdominal layers fold over the femoral region. The severity of pain at FAC was classified using a numeric rating scale (NRS) 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 [FPC] (score of ≥8). Results: The mean (±SD) and median NRS scores were 2.4±2.7 and 1, respectively, in 186 patients included. The proportion of patients with excellent pain control (EPC) was 49.4% (95%CI 42.1%-56.7%) and FPC was 6.9% (95%CI 4.1%-11.6%).  The BH was graded as 1 (n=31), 2 (n=61), 3 (n=48), and 4 (n=46). In multivariate analysis, grade-4 BH [odds ratio (OR) 1.8; 95% confidence interval (CI) 1.3-2.9], grade 4 ease of cannulation (OR 2.1; 95%CI 1.2-2.7), and previous FAC (OR 2.5; 95%CI 1.8-4.2) were independent predictors of FPC. Grade-1 ease of cannulation (OR 1.6; 95%CI 1.2-3.1) independently predicted EPC. Conclusion: Topical EMLA-cream as an adjunct to local lidocaine infiltration was associated with very low rates of FPC during FAC despite a relatively high rate of unfavorable BH.