Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP A-086
Application of Emla Cream Prior to Radial Puncture: An Initiative to Improve Patient Experience
By An Shing Ang, Ki Fung Cliff Li, Paul JL Ong, Nur Fatin Nazira Abdul Malek, Nurul Syahiirah Zulkefli Mat Yusuff, Hee Hwa Ho
Presenter
An Shing Ang
Authors
An Shing Ang1, Ki Fung Cliff Li1, Paul JL Ong2, Nur Fatin Nazira Abdul Malek1, Nurul Syahiirah Zulkefli Mat Yusuff1, Hee Hwa Ho1
Affiliation
Tan Tock Seng Hospital, Singapore1, Heart Specialist International, Singapore2
View Study Report
TCTAP A-086
Vascular Access (Transradial)
Application of Emla Cream Prior to Radial Puncture: An Initiative to Improve Patient Experience
An Shing Ang1, Ki Fung Cliff Li1, Paul JL Ong2, Nur Fatin Nazira Abdul Malek1, Nurul Syahiirah Zulkefli Mat Yusuff1, Hee Hwa Ho1
Tan Tock Seng Hospital, Singapore1, Heart Specialist International, Singapore2
Background
The radial approach is standard of care for coronary angiogram as it confers a lower incidence of major vascular access related complications and allows for early mobilization.
This study aims to evaluate the effectiveness of eutectic mixture of local anesthesia (EMLA) cream in reducing pain as part of an initiative to improve patient experience after radial puncture.
This study aims to evaluate the effectiveness of eutectic mixture of local anesthesia (EMLA) cream in reducing pain as part of an initiative to improve patient experience after radial puncture.
Methods
218 patients booked for elective coronary angiogram were recruited. EMLA cream was applied prior to radial artery puncture. All patients were given subcutaneous lignocaine at the puncture site. We evaluated the mean pain score amongst the whole population.
Within this population, 71 of them had previous coronary angiograms performed without EMLA application. We compared the degree of radial pain with and without EMLA application in this group of patients.
Radial pain was measured by the numeric pain rating scale (NPRS).
Within this population, 71 of them had previous coronary angiograms performed without EMLA application. We compared the degree of radial pain with and without EMLA application in this group of patients.
Radial pain was measured by the numeric pain rating scale (NPRS).
Results
The mean pain score of the whole study population was 2.48. Majority of patients (83.1%) felt that application of EMLA cream was necessary to improve their experience.
Analysis of patients who had no EMLA application for previous coronary angiogram showed that radial pain was significantly lower with EMLA application. (NPRS: 4.41 vs 2.57, p= <0.01). Age, gender and the indication of elective coronary angiogram did not significantly affect the reduction in pain score.
The mean duration of EMLA application prior to radial puncture was 53.1 minutes. The duration was not significantly associated with reduction of radial pain.
Analysis of patients who had no EMLA application for previous coronary angiogram showed that radial pain was significantly lower with EMLA application. (NPRS: 4.41 vs 2.57, p= <0.01). Age, gender and the indication of elective coronary angiogram did not significantly affect the reduction in pain score.
The mean duration of EMLA application prior to radial puncture was 53.1 minutes. The duration was not significantly associated with reduction of radial pain.
| Pain score before | Pain score after | P value | |
| Total population (n=71) | 4.41 | 2.57 | <0.001 |
| Male (n = 61) | 4.39 | 2.52 | <0.001 |
| Female (n = 10) | 4.50 | 2.89 | <0.001 |
| Reduction in pain score | P value | |
| GENDERMaleFemale | 1.911.50 | 0.551 |
| AGE31-4041-5051-6061-70>70 | 1.502.602.122.110.89 | 0.231 |
| INDICATION FOR CORONARY ANGIOGRAM AnginaPositive stress testAbnormal CTCAPre-valvular surgery/pre-renal transplant work upOthers | 2.001.911.00-1.002.00 | 0.162 |
Conclusion
Application of the EMLA cream is easy and effective in reducing pain in patients undergoing coronary angiogram via radial approach. This appears to be well received amongst the patients. The reduction in radial pain may help to reduce the sympathetic drive of these patients and possibly reduce incidence of radial artery spasm which can represent a significant challenge to access and reduce procedural success rate.