Abstract
Introduction: The hemodialysis patients frequently experience the pain and anxiety induced by arteriovenous fistula (AVF) cannulation. This painful intervention, if repeated, imposes destructive psychosomatic effects on patients. Hence, the use of appropriate procedures to reduce pain in these patients is of utmost importance. Objectives: The present study aimed at investigate efficacy of lidocaine spray and topical eutectic mixture of local anesthetics (EMLA) cream in releiving pain induced by arteriovenous fistula cannulation in hemodialysis patients. Patients and Methods: This quasi-experimental study was conducted on 40 patients with arteriovenous fistula (AVF) selected on the basis of purposive sampling method in 2015 in hemodialysis ward of Shahid-Sadoughi hospital. Pain severity was measured at AVF cannulation using EMLA analgesic cream and lidocaine spray with the pain severity numerical scale. Repeated measures analysis of variance (ANOVA) was used in data analysis using SPSS 16. Results: Findings showed that the mean scores of the three methods of pain management, i.e., no pain control method, lidocaine spray, and EMLA analgesic cream, were 7.45±0.88, 4.22±1.33, and 2.8±0.70, respectively. There was a considerable reduction in pain severity using the lidocaine spray and EMLA analgesic cream compared to the conventional method (P<0.001). EMLA analgesic cream caused a greater reduction in pain rate compared to lidocaine spray (P<0.001). Conclusion: This study suggested that EMLA analgesic cream was more effective in reducing pain caused by AVF cannulation. Hence, it is recommended that the hemodialysis patients apply EMLA analgesic cream themselves at the time of the procedure to reduce the cannulation pain.
Highlights
The hemodialysis patients frequently experience the pain and anxiety induced by arteriovenous fistula (AVF) cannulation
eutectic mixture of local anesthetics (EMLA) analgesic cream in hemodialysis excluded from the study due to their lack of cooperation and, 40 patients participated in the study
A two-by-two comparison of the methods revealed that the mean pain score was smaller using either the lidocaine spray or the EMLA analgesic cream compared to the conventional method without pain management (P < 0.001)
Summary
The hemodialysis patients frequently experience the pain and anxiety induced by arteriovenous fistula (AVF) cannulation This painful intervention, if repeated, imposes destructive psychosomatic effects on patients. Objectives: The present study aimed at investigate efficacy of lidocaine spray and topical eutectic mixture of local anesthetics (EMLA) cream in releiving pain induced by arteriovenous fistula cannulation in hemodialysis patients. The pain relief theory behind lidocaine application is the blocking of active and inactive sodium channels followed by blocking of conduction and lack of stimulation resulting in reduced or impaired pain transmission [19] Another topical analgesic is topical eutectic mixture of local anesthetics (EMLA) cream which is a eutectic mixture of lidocaine (2.5%) and prilocaine (2.5%). The results of the study by Turkmen et al revealed that 2.5% lidocaine had no effect on decreasing the pain of phlebotomy in children affected by chronic renal failure who were under hemodialysis [23]
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