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

Patients with end stage renal failure consider the pain causedby recurrent fistula cannulations as the most intense stressthey experience from their treatment and the biggest concernin their lives. One of the fundamental objectives of the nursingprocedures is to relieve this pain. Therefore, this study aimedto determine the impact of two topical medications, namelyPiroxicam and EMLA cream, on the pain caused by fistulacannulation among hemodialysis patients. This was a clinicaltrial conducted on 75 patients referring to the dialysis unit ofthe 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 questionnaireconsisting of three parts: demographic information, the visualanalog scale (VAS) for pain assessment, and a checklist for thelikely side effects of the medications. The severity of pain duringfistula cannulation was assessed in the three groups in two stages(before and after the intervention). To analyze the data, theKruscal-Wallis and the Mann-Whitney statistical tests and SPSS19 were used. The median for pain relief was obviously higherin the EMLA cream group than in either the Piroxicam or theplacebo group and this difference was statistically significant(p<0.001). Comparing the Piroxicam and the placebo showedthat the pain reduction median was much higher in thePiroxicam group than the placebo group, but the difference wasnot significant. The results of this study showed that the EMLAcream is more effective than the Piroxicam gel in the reductionof pain caused by fistula cannulation among hemodialysispatients. Therefore, based on the results of the present study, itcan be suggested that the EMLA cream, as a simple treatmentmethod which can be applied by the patient himself/herself, beused to relieve pain during fistula cannulation of hemodialysispatients.