COMPARITIVE ANALYSIS OF ICE AND LOCAL ANESTHETIC CREAM FOR MITIGATING FISTULA NEEDLE INSERTION PAIN DURING HEMODIALYSIS

Introduction:

Hemodialysis (HD) is the most common form of renal replacement therapy for end-stage renal disease (ESRD) patients in India. The only time during the treatment that the patient perceives pain is at the time of the AVF needle insertion. Many patients are therefore fearful of the dialysis treatment itself on account of this. Some patients find it helpful to apply a local anesthetic cream to reduce the pain; however, this comes at an additional cost to the dialysis treatment. Any measure to relieve pain on AVF needle puncture helps in decreasing anxiety, improves patient comfort, and could potentially ensure compliance with the dialysis treatments. This study compared the subjective reduction of needle insertion pain by the application of ice and a local anesthetic cream at the needle insertion site.

Methods:

This study was conducted at four hemodialysis centers in Mumbai and included 181 consenting patients, with 83 of them having a proximal AVF and 98 having a distal AVF. Two pain management interventions were utilized: 1) topical local anesthetic cream (Prilocaine 25mg+Lidocaine 25mg) and 2) local ice application. The needles were inserted at the same site during all four sessions. The patient’s perception of the needle insertion pain without any intervention was compared in a crossover fashion with the above two interventions. The first session was performed without any pain management intervention, serving as a baseline for comparison. During the second session, the topical local anesthetic was applied on the skin 20 minutes before needle insertion. The third wash-out session was where no pain management intervention was used. During the fourth session, an ice pack was applied at the fistula puncture site for 20 minutes prior to needle insertion. Patients were asked to subjectively assess the severity of perceived pain on a scale of 0 to 4 for each session, where 0 indicated no pain, 1 showed mild pain, 2 indicated moderate pain, 3 indicated severe pain and 4 indicated very severe pain. The pain scores were then analyzed to evaluate the effectiveness of the two pain management techniques. Wilcoxon signed-rank test was used to compare the pain scores between interventions.

Results:

The two pain management interventions significantly reduced pain compared to no intervention. The mean pain score at baseline session 1 was 1.60 ±0.69. At session two on use of the topical anesthetic cream, the mean pain score reduced to 0.94 ±0.61. The pain score during the third session where no intervention (washout period session) was 1.41 ±0.65. In session 4, with ice as the intervention, the mean pain score reduced to 0.85 ±0.59. The type of dialysis centre, public or private, and type AVF, distal or proximal, did not alter the results significantly.

Conclusions:

The application of a local anesthetic cream or local ice both effectively reduced pain experience in patients during AVF needle insertion. The topical cream, which incurs some cost, reduced the mean pain score to 0.94, whereas the free ice application achieved a slightly lower mean pain score of 0.85. Both interventions provided significant pain relief compared to no intervention. Given the cost advantage of ice over a local anesthetic cream, this is a practical and effective option to mitigate pain during AVF needle insertion.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.