Comparison of two topical analgesic strategies for radial artery access. The CATDOL study

Introduction and objectives:There is no widely accepted protocol for topical analgesia before local anesthetic infiltration during radial artery cannulation.This study evaluated the association between 2 topical analgesic strategies and pain intensity during local anesthetic infiltration (time point 1) and after arterial sheath insertion (time point 2).Methods: This was a prospective, observational, nonrandomized study.Patients were assigned to 3 groups: analgesic cream (n = 71), cold spray (n = 74) and control (n = 70).Pain was assessed using a visual analogue scale (VAS).Demographic and clinical variables potentially associated with pain intensity were recorded.Results: Between August 2024 and January 2025, a total of 215 patients were included.At time point 1, the mean VAS score was 4.37 ± 2.0 in the control group, 3.61 ± 1.7 in the cream group and 3.12 ± 1.5 in the cold spray group (P < .001).In the multivariate model, cream and cold spray were associated with adjusted reductions of 0.70 points (95%CI, -1.28 to -0.12; P = .017)and 1.22 points (95%CI, -1.79 to -0.65; P < .001).At time point 2, VAS scores were 3.54 ± 2.3, 2.41 ± 2.2 and 2.71 ± 2.0, respectively.Overall, 13.0% of patients experienced high-intensity pain, exploratorily defined as VAS ≥ 6, at time point 1; this finding was more frequent in the control group.The mean time from application to puncture was shorter with cold spray than with the cream.Conclusions: Topical analgesic pretreatment was associated with lower pain intensity during radial artery cannulation.No statistically significant differences were observed between topical analgesic cream and cold spray.Cold spray required less application time and had a lower direct cost, which may facilitate its implementation in cath labs.