Comparison of two topical medications, on pain relief due to fistula cannulation in hemodialysis patients

Year 2017, Volume: 21 Issue: 4, 1002 - 1009, 01.12.2017

Farideh Malekshahı Shirzad Fallahı Mehdi Mohsenı Mohammad Almasıan

Abstract

Patients with end stage renal failure consider the pain caused

by recurrent fistula cannulations as the most intense stress

they experience from their treatment and the biggest concern

in their lives. One of the fundamental objectives of the nursing

procedures is to relieve this pain. Therefore, this study aimed

to determine the impact of two topical medications, namely

Piroxicam and EMLA cream, on the pain caused by fistula

cannulation among hemodialysis patients. This was a clinical

trial conducted on 75 patients referring to the dialysis unit of

the Shohadaye Ashayer Hospital of Khorramabad, West of Iran,

in 2013. The patients were randomly divided into three groups:

group A (Piroxicam), group B (EMLA cream), and group C

(placebo). The data collection instrument was a questionnaire

consisting of three parts: demographic information, the visual

analog scale (VAS) for pain assessment, and a checklist for the

likely side effects of the medications. The severity of pain during

fistula cannulation was assessed in the three groups in two stages

(before and after the intervention). To analyze the data, the

Kruscal-Wallis and the Mann-Whitney statistical tests and SPSS

19 were used. The median for pain relief was obviously higher

in the EMLA cream group than in either the Piroxicam or the

placebo group and this difference was statistically significant

(p<0.001). Comparing the Piroxicam and the placebo showed

that the pain reduction median was much higher in the

Piroxicam group than the placebo group, but the difference was

not significant. The results of this study showed that the EMLA

cream is more effective than the Piroxicam gel in the reduction

of pain caused by fistula cannulation among hemodialysis

patients. Therefore, based on the results of the present study, it

can be suggested that the EMLA cream, as a simple treatment

method which can be applied by the patient himself/herself, be

used to relieve pain during fistula cannulation of hemodialysis

patients.

Keywords

Topical medications; pain relieve; fistula cannulation; hemodialysis patients

References

• 1. Schere JC, Timby BK, Smith NE. Introductory Medical Surgical Nursing. Lippincott Co, W.B. Philadelphia. 1999, pp 346. 2. Boggs Underman K, Arnold E. Interpersonal Relationships: professional communication skills for nurses, Fourth Ed. Saunders Company. 2003, pp 346. 3. Brenna A. Caring for children during procedure: A review of the literature. Pediatric Nurs 1994; 20: 457. 4. Harris TJ, Nazir R, Khetpal P, Peterson RA, Chava P, Samir SS, Kimmel PL. Pain, sleep disturbance and survival in hemodialysis patients. Nephrol Dial Transplant 2012; 27: 758- 65. 5. P B S, Khakha DC, Mahajan S, Gupta S, Agarwal M, Yadav SL. Effect of cryo-therapy on arteriovenous fistula puncturerelated pain in hemodialysis patients. Indian J Nephrol 2008;18:155-8. 6. Quinn RR, Lamping DL, Lok CE, Meyer RA, Hiller JA, Lee J, Richardson EP, Kiss A, Oliver MJ. The vascular access questionnaire: Assessing patient-reported views of vascular access. J Vasc Access 2008; 9:122-8. 7. McLaughlin K, Manns B, Mortis G, Hons R, Taub K. Why patients with ESRD do not select self-care dialysis as a treatment option. Am J Kidney Dis 2003; 41: 380-5. 8. Zakeri Moghadam M, Aliasgharpoor M. Comprehensive Book. Intensive nursing cares in CCU, ICU, and Dialysis wards; (In Persian). Andishe Rafie. 2009, pp 277-362. 9. Aghighi M, Rouchi HA, Zamyadi M, Mahdavi-Mazdeh M, Norouzi SH, Rajolani H, Ahrabi S, Zamani M. Dialysis in Iran. Iranian J Kidney 2008; 2: 11-5. 10. Burk K, Lemone P. Medical-surgical nursing care, 2nd edition. Pearson Education, New Jersey. 2007, pp 234. 11. Malek F, Tousi J, Tamadon M, Mousavy Sh, Malek M, Ghaderi M. The roles of filters in hypoxia at hemodialysis patients. J. Shahid Sadoughi Univ Med Sci 2008; 16: 34-9. (In Persian) 12. Tanyi RA, Werner JS. Women’s Experience of spirituality within end-stage renal disease and hemodialysis. Clin Nurse Res 2008; 17: 32-49. 13. Reis EC, Roth EK, Syphan JL, Tarbell SE, Holubkov R. Effective pain reduction for multiple immunization injections in young infants. Arch Pediatrics Adolescent Med 2003; 157:1115-20. 14. Irsfeld S, Klement W, Lipfert P. Dermal anesthesia: comparison of EMLA CREAM with iontophoretic local anaesthesia. British J Anesthesiol 1993; 71: 375-8. 15. Minassian VA, Jazayeri A, Prien SD, Timmons RL, Stumbo K. Randomized trial of lidocaine ointment versus placebo for the treatment of postpartum perineal pain. Obstetric Gynecol 2002; 100: 1239-43. 16. Manual of dermatologic theraqeutic. Editor : Ardent K. Little Brown, USA. 1995, pp 261-262. 17. Tanyal R, Ostrow Cl. The use of EMLA CREAM to decrease venipuncture pain in children. Pediatric Nurs 2004; 202. 18. Wong L. Whaley & Wong`s nursing care of infant and children, 8th edition. Mosby Inc. 2007, pp 205. 19. Buckley MMP. Benfield Eutectic lidocaine/prilocaine cream. A review of the topical anaesthetic/analgesic efficacy of a eutectic mixture of local anaesthetics EMLA CREAM. Drugs 1993; 46: 126-51. 20. De Jong PC, Verburg MP, Lillieborg S. EMLA CREAM ® versus ethyl-chloride spray: a comparison of the analgesic efficacy in children. Eur J Anesthesiol 1990; 7: 473-81. 21. Lander JA, Weltman BJ, So SS. EMLA CREAM and amethocaine for reduction of children’s pain associated with needle insertion. Cochrane Database System Rev 2006; 3: 004236. 22. Hahn IH, Hoffman RS, Nelson LS. EMLA CREAM-induced methemoglobinemia and systemic topical anesthetic toxicity. J Emerg Med 2004; 26: 85-8. 23. Dutta A, Puri GD, Wig J. Piroxicam gel, compared to EMLA CREAM is associated with less pain after venous cannulation in volunteers. Canadian J Anesthesiol 2003; 50: 775-8. 24. Poelman MC, Piot B, Guyon F, Deroni M, Leveque JL. Assessment of topical non-steroidal anti-inflammatory drugs. J Pharm Pharmacol 1989; 41: 720-2. 25. Ahmadinejad M, Delfan B, Haghdani S, Hashemi M, Khan IA, Tafti MT. Comparing the effect of diclofenac gel and piroxicam gel on mastalgia. Breast J 2010; 16: 213-4. 26. Potter PA, Perry AG. Fundamental of nursing, 6th edition. Mosby, St Louis. 2003, pp 708-711. 27. Williamson A, Hoggart B. Pain: A Review of Three Commonly Used Pain Rating Scales. J Clin Nurs 2005; 14: 798-804. 28. Potter PA, Perry AG. Fundamentals of Nursing, (Translation for Salemi S, Najafi T). Salemi Publication. 2013, pp 502-542. 29. Asgari M, Hoshmand Motlagh N, Soleimani M, Ghorbani R. The effect of lidocaine spray on pain during vascular inserting needles in hemodialysis patients. Komesh 2013; 3: 271-80. (In Persian) 30. Namadi M, Movahedpour A. Quality of life in patients after renal transplantation in comparison with intermittent hemodialysis. J Ardabil Univ Med Sci 2009; 9:171-9. (In Persian) 31. Asgari MR, Soleimani M. Comprehensive book Intensive nursing cares in CCU, ICU, and Dialysis wards, 18th edition. Boshra 2012; 391-3. (In Persian) 32. Van Loon MM, Goovaerts T, Kessels AG, van der Sande FM, Tordoir JH. Buttonhole needling of hemodialysis arteriovenous fistulae results in less complications and interventions compared to the rope-ladder technique. Nephrol Dial Transplantat 2010; 25: 225-30. 33. Monfared A, Orang poor R, Moosavian Roshan Zamir SA, Aghajani Nargesi D. Reasons of chronic renal failure in hemodialysis patients in Guilan province. J. Guilan Univ Medical Sci 2003; 12:76-83. (In Persian) 34. Noblat AC, Lopes MB, Lopes GB, Lopes AA. Complications of hypertension in men and women seen in a referral outpatient care unit. Arq Bras Cardiol 2004; 83: 314-9. 35. Agarwal A, Gautam S, Gupta D, Singh U. Transdermal diclofenac patch vs eutectic mixture of local anesthetics for venous cannulation pain. Canadian J Anesthesiol 2007; 54:196-200. 36. Çelik G, Özbek O, Yılmaz M, Duman I, Özbek S, Apiliogullari S. Vapocoolant spray vs Lidocaine/Prilocaine cream for reducing the pain of venipuncture in hemodialysis patients: A randomized, placebo-controlled, crossover study. Int J Med Sci 2011; 8: 623-7. 37. Ingalls NK, Horton ZA, Bettendorf M, Frye I, Rodriguez C. Randomized, double-blind, placebo-controlled trial using lidocaine patch 5% in traumatic rib fractures . J Am Coll Surg 2010; 210: 205-9. 38. Moore RA, Tramer MR, Carroll D, Wiffen PJ, McQuay HJ. Quantitative systemic review of topically applied nonsteroid anti-inflammatory drugs. BMJ 1998; 316: 333-8. 39. Khalili Shomia S, Safavi M, Yahyavi SH, Farahani H. Assessment of the effect of EMLA cream on vein puncture pain severity with vein catheter in the patients undergoing cesarean section: Randomized placebo controlled trial. J. Mazandaran Univ Sci 2012; 22: 82-8. (In Persian) 40. Galinkin J, Rose J, Harris K, Watcha M. Lidocaine iontophoresis versus eutectic mixture of local anesthetics (EMLA CREAM ®) for IV placement in children. Anest Anal 2002; 94: 1484-8. 41. Pourmovahed Z, Dehghani Kh, Yassinie M, Shakiba M, Tavangar H, Shahrie T. Comparative study of the effect of music distraction and Emla cream on pain of the children during intravenous cannulation. Iran J Nurs 2008; 21: 47-53. 42. Nikfarid L, Ghamar Yousefi R, Namaziyan M, Namdar F, Azam Nezami M. Comparison of EMLA cream versus local refrigeration for reducing venipuncture-related pain in pediatric patients of Children’s Medical Center, 2008. J Nursing Res 2010; 5: 32-7. 43. Pérez-Pérez LC, Fernández-Redondo V, Ginarte-Val M, Paredes-Suárez C, Toribio J. Allergic Contact dermatitis from EMLA cream in a hemodialyzed patient. Dermatitis 2006; 17: 85–7. 44. Wehle B, Björnström M, Cedgård M, Danielsson K, Ekernäs A, Gutierrez A, Petterson U, Lindholm T. Repeated application of EMLA cream 5% for the alleviation of cannulation pain in haemodialysis. Scand J Urol Nephrol 1989; 23: 299-302. 45. Haji Hosseini F, Beheshti Z, Nazari R, Rezai R, Hagi Ahmadi M. Comparison of moist warm compresses and topical gel piroxicam on phlebitis caused by peripheral venous catheter. J Babol Univ Sci. 2006; 9: 33-7. (In Persian) 46. Bergquist D, Brunkwall J, Jensen N, Persson NH. Treatment of superficial thrombophlebitis: A comparative trial between placebo, hirudoid cream and piroxicam gel. Ann Chir Gynaecol 1990; 79: 92-6.