A safe and efficient analgesic approach for percutaneous transluminal angioplasty: Fentanyl plus targeted local anesthesia

BACKGROUND: Stenosis is a common complication of arteriovenous access (AV), for which percutaneous transluminal angioplasty (PTA) is a well-established intervention. Nevertheless, balloon dilation commonly induces pain. Common analgesic approaches during PTA encompass moderate intravenous sedation and analgesia, brachial plexus block, and local infiltrative anesthesia, each with its own limitations. A need currently exists for a safe, simple, and effective analgesic approach during PTA. METHODS: This retrospective observational study was conducted between January 2020 and July 2022 at a single tertiary medical center. Patients with AV access dysfunction undergoing PTA were included. Patients were allocated into two groups based on the analgesia approach: one group received intraluminal fentanyl injection alone, and the other a combination of intraluminal fentanyl and local lidocaine infiltration at the stenotic site. Data regarding AV access type, lesion locations, 11-point Numerical Rating Scale (NRS) scores and procedural complications were collected. Comparative analysis between groups was conducted using appropriate statistical methods, and significance was set at p < 0.05. RESULTS: A total of 120 patients (mean age, 62.9±11.8 years; 65% male) were included in the study: 34 in the fentanyl-only group (Group A) and 86 in the fentanyl combined with lidocaine group (Group B). Group A had a higher proportion of male patients compared to Group B (79.4% vs. 59.3%, p = 0.037). No significant differences were found in balloon size, inflation pressure, fluoroscope time, or procedural complications between groups. The primary outcome, procedural pain, was significantly lower in Group B as compared to Group A (NRS score 2.3 ± 0.9 vs. 5.1 ± 2.2, p < 0.001), and this analgesic advantage remained after adjusting for gender and age. CONCLUSION: Our study findings suggest that administering a combination of intraluminal fentanyl and a direct lidocaine injection in patients undergoing percutaneous transluminal angioplasty is both an efficient and safe analgesic procedure for PTA.