Evaluation of the prophylactic role of pethidine in avoiding radial artery spasm during transradial cardiac interventions

Abstract

Abstract Introduction Prophylactic use of benzodiazepine and opioids (fentanyl, morphine) is an established method for tackling radial artery spasm, in patients undergoing left cardiac catheterization procedures. Meperidine (Pethidine) is a synthetic opioid with elimination half life of 2–4 hours and duration of action of only 2–3 hours, making it ideal for in-lab administration. Purpose We aimed to test primarily the role of pethidine administration in preventing radial artery spasm and secondarily to assess patient discomfort during transradial coronary interventions. Methods This is a prospective, randomized, double blinded study. Patients were randomized to either pethidine 0,25mg administration (Group A) or normal saline (Group B) i.v. 10 minutes before the beginning of the procedure. As standard prophylactic measures against spasm, both groups received verapamil 5mg and nitroglycerin 100μg, after sheath introduction in the radial artery. Artery spasm was assessed clinically by the difficulty in advancing or exchanging catheters, as reported by the operator (CHUGH scale). A Visual Analog Scale (VAS) was used to estimate the patient-perceived discomfort, one hour after the end of the procedure. Results 66 patients were included, 42 in Group A and 24 in Group B. Mean age of the patients was 65.9 years, mean duration of the procedure was 27 minutes and 24% of patients proceeded to PTCA overall. Operators reported no problems in catheter manipulations (CHUGH 0) in 67% of patients from Group A vs 38% of pts from Group B. 64% Group A patients and 21% Group B patients reported no symptoms (VAS 0). Pethidine administration had a negative correlation with VAS (r: −0.418, p: 0.001) and CHUGH Scale (r: −0.295, p: 0.016) scores. Conclusion Pethidine low dose administration before radial artery catheterization, shows a positive trend in preventing spasm and reducing procedure-related patient discomfort. Larger studies are required to evaluate the role of pethidine as an alternative prophylactic measure against artery spasm in transradial cardiac interventions. Funding Acknowledgement Type of funding sources: None.