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

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.