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Review
. 2024 Jul 16;16(7):e64682.
doi: 10.7759/cureus.64682. eCollection 2024 Jul.

Efficacy of Local Anesthesia for Radial Artery Puncture Pain: A Systematic Review and Network Meta-Analysis

Shunsuke Yasuo  1   2 , Minoru Hayashi  3   2 , Chiaki Suda  4   2 , Yuki Kataoka  5   6   2   7 , Shunsuke Taito  8   2 , Eriya Imai  9   2 , Kohei Sazanami  10
Affiliations
Review

Efficacy of Local Anesthesia for Radial Artery Puncture Pain: A Systematic Review and Network Meta-Analysis

Shunsuke Yasuo et al. Cureus. .

Abstract

We performed a systematic review and network meta-analysis (NMA) to assist clinicians in determining the optimal patient-specific method of analgesia during radial artery puncture by comparing radial artery puncture procedural pain. We included randomized controlled trials that assessed the prophylactic efficacy of local anesthesia for radial artery puncture-associated pain. We searched the Medical Literature Analysis and Retrieval System Online in January 2023, the Cochrane Central Register of Controlled Trials in January 2023, the Excerpta Medica Database in December 2022, the World Health Organization International Clinical Trials Platform Search Portal in January 2023, and ClinicalTrials.gov in January 2023. We synthesized the pain scores (0-100 scale) using the frequentist random-effects NMA model. We evaluated the confidence in each outcome using the CINeMA tool (https://cinema.ispm.unibe.ch/). We conducted an NMA of 1,619 patients across 14 studies on pain scores during radial artery puncture-related procedures for 12 interventions. Compared with placebo, mepivacaine infiltration and lidocaine spray probably reduce pain (mean difference (MD): -47.67, 95% confidence interval (CI): -61.45 to -33.89, confidence rating (CR): moderate; MD: -27.38, 95% CI: -37.53 to -17.22, CR: moderate). Of the 32 studies included, none reported systemic adverse events, such as anaphylaxis or local anesthetic systemic toxicity, or severe local adverse events. In conclusion, mepivacaine infiltration and lidocaine spray probably reduce the pain associated with radial artery puncture more than other local anesthesia.

Keywords: analgesia; local anesthesia; network meta-analysis; pain management; radial artery puncture; systematic review.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. NMA for pain scores during radial artery puncture-related procedures
The numbers above the lines represent the number of RCTs in direct comparisons. The size of the nodes reflects the number of direct comparisons in which the intervention took place. EMLA: eutectic mixture of local anesthetic cream of prilocaine and lidocaine, NMA: network meta-analysis, RCTs: randomized controlled trials Image Credit: Author
Figure 2
Figure 2. PRISMA 2020 flow diagram
CENTRAL: Cochrane Central Register of Controlled Trials, Embase: Excerpta Medica Database, ICTRP: World Health Organization International Clinical Trials Platform Search Portal, MEDLINE: Medical Literature Analysis and Retrieval System Online, PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 3
Figure 3. Forest plot for all interventions compared with placebo in pain scores during radial artery puncture-related procedure
We conducted an NMA with 1,619 patients from 14 studies on pain scores during radial artery puncture-related procedures for 12 interventions [2,3,14–16,34,39,40,44,46,49,50,52,53]. EMLA: eutectic mixture of local anesthetic cream of prilocaine and lidocaine, NMA: network meta-analysis, MD: mean difference, CI: confidence interval
Figure 4
Figure 4. Forest plot for all interventions compared with placebo in pain scores during radial artery puncture alone
We conducted an NMA with 3,171 patients from 27 studies on pain scores during radial artery puncture alone for 13 interventions [2,3,10,14–17,34–39,41–54]. EMLA: eutectic mixture of local anesthetic cream of prilocaine and lidocaine, NMA: network meta-analysis, MD: mean difference, CI: confidence interval
Figure 5
Figure 5. Forest plot of subgroup analysis in pain scores during radial artery puncture-related procedures
A: Radial artery puncture for CAG or PCI. B: Radial artery puncture for ABG or cannulation for continuous blood pressure monitoring or blood sampling. We conducted a subgroup analysis of the radial artery puncture-associated pain scores between radial artery puncture for CAG or PCI [39,40] vs. ABG or cannulation for continuous blood pressure monitoring or blood sampling [2,3,14–16,34,44,46,49,50,52,53]. EMLA: eutectic mixture of local anesthetic cream of prilocaine and lidocaine, ABG: arterial blood gas sampling, CAG: coronary angiography, PCI: percutaneous coronary intervention, MD: mean difference, CI: confidence interval
Figure 6
Figure 6. Forest plot of sensitivity analysis in pain scores during radial artery puncture-related procedures: exclusion of studies using imputed statistics
A: Interventions forming a network connected by lidocaine infiltration. B: Interventions forming a network connected by placebo. We undertook a sensitivity analysis of radial artery puncture-associated pain scores by excluding studies that used imputed statistics [15,34,39,40,44,46,49,52,53]. EMLA: eutectic mixture of local anesthetic cream of prilocaine and lidocaine, MD: mean difference, CI: confidence interval
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