<b>Clinical Efficacy of a Combined Topical Gel of Diltiazem, Papaverine, and Lidocaine on Pain, Spasm, and Hand Function in Patients Undergoing Trans-Radial Coronary Catheterization</b>

Background: Trans-radial coronary catheterization has been known as a routine procedure performed for the patients suffering from coronary artery diseases. Despite the benefits, it would come with many complications. In this regard, this study aims to investigate the clinical efficacy of a combined topical gel containing diltiazem, lidocaine, and papaverine on pain, spasm, and hand function in patients undergoing trans-radial coronary catheterization. Methods: In this randomized, quadruple-blind clinical trial, the candidates for trans-radial coronary artery interventions were randomly assigned to the intervention (receiving the combined topical gel) and the control (receiving the placebo) groups. The gels were applied around the radial artery 30 to 60 minutes prior to the catheterization and pain assessment in the forearm was conducted before and two hours after the procedure. Hand function was evaluated prior to the intervention, after catheter removal, and two hours post-removal, with a focus on the levels of numbness, stiffness, and weakness in the fingers. The occurrence of spasms during the procedure was measured using the clinical spasm scale tailored for the radial artery. Furthermore, sympathetic tone was evaluated through systolic and diastolic blood pressure and heart rate measurements before and after catheterization, as well as two hours post-procedure. Results: Based on the results, significant alleviations in pain (two hours post-catheterization) and hand numbness were recorded for the intervention group when compared to the control group. Furthermore, the number of attempts required to access the radial artery was significantly lower in the intervention group than in the control group. Conclusion: The data showed that, the current combination can be a candidate to alleviate some of the complications associated with trans-radial coronary catheterization. However, further preclinical and clinical studies may be required in this regard.