Analgesia for pediatric arteriovenous fistula cannulation in hemodialytic patients: A comparison of lidocaine gel, lidocaine spray, and needle plate

Abstract

Background: Children undergoing hemodialysis (HD) via arteriovenous fistula (AVF) experience approximately 300 painful punctures per year which may lead to non-compliance with HD. This study was conducted to show the effect of local anesthetics on pain perception in AVF cannulation. Methods: This randomized clinical trial included 20 children under HD via AVF in Sheikh Children's Hospital Hemodialysis Center in February 2014. The first intervention was conducted as the baseline pain assessment (control), then every patient randomly received all three other interventions: Lidocaine gel, lidocaine spray, and needle plate, before venipuncture. Pain perception was expressed and recorded by patients using the visual analogue scale (VAS). VAS scores were compared, and a P value of <0.05 was considered significant. Results: The VAS mean in lidocaine spray state, lidocaine gel state, and needle plate state was respectively 47.87, 51.31, and 49.43, which were significantly less than the control state with the VAS mean of 60.06 (lidocaine spray vs. control P value = 0.001, lidocaine gel vs. control P value = 0.001, and needle plate vs. control P value = 0.003). Conclusion: Our study showed that the use of needle plate, lidocaine spray, and lidocaine gel are all equally effective ways in controlling the degree of pain in AVF needling in children undergoing HD.

Vaginal artery pseudoaneurysm after a hysterectomy: A case report and review of the literature

“…There are several reports in case of iatrogenic vascular injury during uterine curettage or surgical trauma that are classified as arteriovenous malformations (AVMs), arteriovenous fistulas, direct vessel ruptures, and pseudoaneurysms. 8 , 9 An arterial pseudoaneurysm is the formation of a periarterial bloody cyst that communicates with the arterial lumen through a narrow neck. It seems that pseudoaneurysms are more infrequent than other injuries.…”

Comparison of the Effectiveness of EMLA Cream, 2% Lidocaine Gel, and Ice Bag on Pain Intensity Caused by Venipuncture in Children Aged 6-12 Years

“…Lidocaine is a local anesthetic drug with a moderate effect and a short onset of action, which blocks the transmission of nerve messages in acute and chronic pain by inhibiting voltage-dependent sodium ion channels [11]. In this regard, the results of Ravanshad et al showed that the use of lidocaine gel has been associated with a reduction in pain during hemodialysis venipuncture in children [12]. A meta-analysis by Ghojazadeh et al showed the controversial effect of using topical lidocaine gel in reducing the pain caused by venipuncture [11].…”

Cooling spray or lidocaine spray and needle insertion pain in hemodialysis patients: an open-label cross-over randomized clinical trial

“…Research shows that 5.3% and 22% of adults have a severe and moderate fear of needles, respectively [ 5 ]. Nearly two million patients worldwide are dialysis-dependent, and of these, approximately 90% receive hemodialysis (HD) three times weekly [ 6 ].…”

“…The HD is the most frequently used renal replacement therapy, and an arteriovenous fistula (AVF) is the gold standard for vascular access in these patients [ 6 ]. It is true for HD patients who experience a large-diameter needle insertion in the fistula area two to three times a week and about 300 times a year [ 7 ].…”

“…It is true for HD patients who experience a large-diameter needle insertion in the fistula area two to three times a week and about 300 times a year [ 7 ]. Therefore, the pain of the needle insertion to AVFs to perform HD is unbearable and a highly prevalent problem [ 8 , 9 ] that requires pain management techniques for long-term treatment and patients’ comfort [ 6 ]. More than one-fifth of HD patients report this pain as unbearable.…”