Pharmacological interventions for pain management during arteriovenous fistula puncture in adults and adolescents undergoing maintenance haemodialysis: a systematic review

Abstract

IntroductionPain is a stressful experience for patients receiving haemodialysis through arteriovenous fistulas. This systematic review assessed the effectiveness of different pharmacological interventions for reducing pain during cannulation of arteriovenous fistulas among adolescents and adult patients with end-stage renal disease.MethodsThe protocol was prospectively registered with PROSPERO (Registration number CRD42024497355). A PRISMA-compliant systematic literature search was conducted on PubMed, Cochrane CENTRAL and Google Scholar. The primary and secondary outcomes were a reduction in the severity of pain and incidence of side effects respectively.ResultsIn total, 15 studies were included in this review, all of which had some or serious concerns about the risk of bias. Compared with EMLA, cryotherapy with ice packs at the fistula site was superior, with a pain intensity of 1.05 (95% confidence interval 0.21, 1.89) points lower on the visual analogue scale, and there was no difference in the incidence of adverse effects. There was a greater reduction in pain intensity with EMLA cream than with piroxicam gel (mean difference 1.30; 95% confidence interval 0.68, 1.93). No difference in the incidence of adverse effects was noted. Compared with lidocaine spray, EMLA cream was associated with a lesser degree of pain (mean difference 2.09 points; 95% confidence interval 1.81, 2.38). Compared with placebo, cryotherapy with ice packs at the Hoku point was better, with a pain intensity of 2.53 (95% confidence interval 1.23, 3.83) points less on the visual analogue scale.ConclusionsAvailable evidence supports the use of cryotherapy with ice packs and EMLA cream for reducing pain during cannulation of arteriovenous fistulas.