Vapocoolant Spray vs Lidocaine/Prilocaine Cream for Reducing the Pain of Venipuncture in Hemodialysis Patients: A Randomized, Placebo-Controlled, Crossover Study

Abstract

Objective: Patients undergoing hemodialysis are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula. This study was designed to measure pain associated with venepuncture during AVF cannulation and to compare the effectiveness of ethyl chloride vapocoolant spray, topical eutectic mixture of local anesthetics (EMLA) cream and placebo in controlling pain caused by venepuncture of arteriovenous fistula patients undergoing chronic hemodialysis.Methods: This randomized, placebo-controlled, crossover study, included 41 patients undergoing conventional hemodialysis three times a week. First intervention was conducted as baseline pain assessment (control). In the three consecutive dialysis sessions, every patient randomly received 1) ethyl chloride vapocoolant spray, 2) EMLA, or 3) placebo cream before venepuncture. Pain perception was recorded by patients immediately after cannulation on a 0-100 mm visual analogue scale (VAS). p<0.05 was considered as significant.Results: VAS scores presented a marked inter-individual variation during venepuncture. EMLA application resulted in significantly lower total pain scores compared to control and all other interventions (p<0.05). No patient experienced severe pain with EMLA or vapocoolant. The patients reported less moderate and severe pain with EMLA, and vapocoolant spray compared to control and placebo interventions. Moderate and severe pain scores were similar between EMLA and vapocoolant spray (p>0.05).Conclusion: Venipuncture for AVF cannulation causes mild to moderate pain in hemodialysis patients. Although local application of EMLA is more effective than in preventing venepuncture pain, ethyl chloride vapocoolant is as effective as EMLA for preventing mild to moderate puncture pain in patients undergoing hemodialysis.

Fostering safe vascular access for adolescents during hemodialysis using cushion cannulation versus common cannulation techniques

“…Findings of the current study were also in agreement with the study of Celik et al (2011) [23] and Nikki et al (2013), [24] who reported that pain score reduced during artery and vein needle puncture in the study group. On investigating correlations between the level of pain as measured by a numerical pain scale and the cushion cannulation technique, findings of the current study revealed that there was a negative correlation between stabilization of arm and level of pain.…”

“…Also, it was reported to be 325. 22 and 94.46 pmp respectively for children aged [16][17][18][19][20][21][22][23][24][25] years. [2,3] An estimate that three to five adolescents pmp develop chronic renal failure annually, where 70% of them require dialysis for short periods and 23% require prolonged HD support.…”

The add-on effect of the Mutsu-Senshi® skin cooling device for needle insertion pain in hemodialysis patients: a multicenter prospective study

“…It may be associated with depressive symptoms and lower quality of life in patients with HD [19]. Therefore, various methods have been attempted to reduce needle insertion pain [6][7][8][9][10][11]. The buttonhole technique has been expected to decrease pain more effectively than the rope-ladder or rotatingsite cannulation technique [6], but a recent metaanalysis concluded that no difference in cannulation pain was found between the 2 techniques in randomized controlled trials [7].…”

“…In fact, pain during needle insertion is the most common patient complaint regarding hemodialysis access [5]. Several approaches have been developed to minimize needle insertion pain, including buttonhole cannulation technique [6,7], lidocaine-containing local anesthetic cream/ patches [8,9], and lavender essential oil [10,11]. However, their effects are variable and unpredictable.…”

Efficacy of application of eutectic mixture of local anesthetics and lidocaine spray in pain management of arteriovenous fistula cannulation in hemodialysis patients

“…On average, the hemodialysis patients undergo the procedure three times a week, each time lasting 3-4 hours. Moreover, the hemodialysis patients averagely experience the cannulation pain and skin puncture 10 times per month and this pain continues during the lifespan of the patient or until a successful kidney graft is performed (9)(10)(11). The frequent pain induced by fistula cannulation in hemodialysis may result in depression, decreased life quality, pain and agony, distress, and stress in these patients while pain management may lead to the acceptance of hemodialysis by these patients and their improved life quality (12).…”