Effectiveness of EMLA Cream in the Management of Arterio-Venous Fistula Needle Insertion Pain in Haemodialysis Patients

This systematic review is conducted to assess the effectiveness of EMLA-cream in the management of Arterio-Venous Fistula-AVF needle insertion pain in adult haemodialysis-HD patients compared with other alternative interventions. The main search was conducted in November 2020 and was updated on 5th December 2020. In the search strategy, keywords and synonyms were used, and multiple databases were searched with no date limitation to ensure a comprehensive search that would allocate all studies relevant to the review, and to minimize location bias. The following databases were explored: Joanna Briggs Institute (JBI), the International Prospective Register of Systematic Reviews (PROSPERO), Cochrane Library, and the Campbell Collaboration Library of Systematic Reviews. The keywords “EMLA cream”, “Arterio-Venous Fistula needle pain” and “hemodialysis patients” or “haemodialysis patient” were used for a scoping search in Google Scholar, whereas in the databases were ((“EMLA”) OR (“eutectic mixture of local anesthetic*) AND Arteriovenous*) OR “fistula needle* fistula cannula* and (“h#emodialysis patient OR * dialysis patient)). A total of 209 studies were found in this search and were filtered. Initially, any duplicated studies were removed, leaving 89 studies that were relevant to the inclusion and exclusion criteria. Two studies were included from the hand search. There were no studies identified in the grey literature or backward and forward chaining search. Following this initial filtration, the titles and abstracts of the remaining studies were reviewed and 76 were excluded. The full text of 15 studies was read in full and nine were excluded for the following reasons: three studies were focused on mixed participants, six studies used other interventions and one study was a duplicate paper with the same author and different title. Five studies were taken forward for critical appraisal. EMLA-cream is an effective management strategy in reducing AVF needle insertion pain among adult HD-patients. However, despite the positive effect of EMLA cream in reducing HD needle insertion pain, with fewer side effects, the findings should be considered with caution, as there are some limitations, and further research is required. Keywords: EMLA; Pain; Dialysis; Arterio-Venous Fistula