Pain relief for the removal of femoral sheath in interventional cardiology adult patients (Review)

Wensley, C. J., Kent, B., McAleer, M. B., Price, S. M. and Stewart, J. T. 2008, Pain relief for the removal of femoral sheath in interventional cardiology adult patients (Review), Cochrane database of systematic reviews, no. 4, pp. 1-23, doi: 10.1002/14651858.CD006043.pub2.

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Title Pain relief for the removal of femoral sheath in interventional cardiology adult patients (Review)
Author(s) Wensley, C. J.
Kent, B.
McAleer, M. B.
Price, S. M.
Stewart, J. T.
Journal name Cochrane database of systematic reviews
Issue number 4
Start page 1
End page 23
Total pages 23
Publisher John Wiley & Sons
Place of publication Oxford, England
Publication date 2008
ISSN 1469-493X
Keyword(s) anxiolytic agent
glyceryl trinitrate
local anesthetic agent
Summary Pain relief for removal of femoral sheath after cardiac procedures
Procedures for the non-surgical management of coronary heart disease include balloon angioplasty and intracoronary stenting. At the start of each procedure an introducer sheath is inserted through the skin (percutaneously) into an artery, frequently a femoral artery in the groin. This allows the different catheters used for the procedure to be exchanged easily without causing trauma to the skin. At the end of the procedure the sheath is removed and, if the puncture site isn't "sealed" using a device closure, firm pressure is required over the site for 30 minutes or more to control any bleeding and reduce vascular complications. Removing the sheath and the firm pressure required to control bleeding can cause pain, although this is generally mild. Some centres routinely give pain relief before removal such as intravenous morphine, or an injection of a local anaesthetic in the soft tissue around the sheath (called a subcutaneous injection). Adequate pain control during sheath removal is also associated with a reduced incidence of a vasovagal reaction, a potentially serious complication involving a sudden drop of blood pressure and a slowed heart rate. Four studies were reviewed in total. Three trials involving 498 participants compared subcutaneous lignocaine, a short acting local anaesthetic, with a control group (participants received either no pain relief or an inactive substance known as a placebo). Two trials involving 399 people compared intravenous opioids (fentanyl or morphine) and an anxiolytic (midazolam) with a control group. One trial involving 60 people compared subcutaneous levobupivacaine, a long acting local anaesthetic, with a control group. Intravenous pain regimens and subcutaneous levobupivacaine appear to reduce the pain experienced during femoral sheath removal. However, the size of the reduction was small. A significant reduction in pain was not experienced by participants who received subcutaneous lignocaine or who were in the control group. There was insufficient data to determine a correlation between pain relief administration and either adverse events or complications. Some patients may benefit from routine pain relief using levobupivacaine or intravenous pain regimens. Identifying who may potentially benefit from pain relief requires clinical judgement and consideration of patient preference. The mild level of pain generally experienced during this procedure should not influence the decision as some people can experience moderate levels of pain.
Language eng
DOI 10.1002/14651858.CD006043.pub2
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
111502 Clinical Pharmacology and Therapeutics
110201 Cardiology (incl Cardiovascular Diseases)
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2010, The Cochrane Collaboration
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Document type: Journal Article
Collection: School of Nursing and Midwifery
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