A comparison between the effects of topical piroxicam and EMLA cream on fistula cannulation pain in hemodialysis patients

Patients with end-stage renal failure, consider recurrent fistula cannulation pain as the most severe stress, resulted from the treatment process, and a major concern of their life. Nurses as one of the main targets of their actions, have a duty to relieve the pain. Accordingly, this study was conducted to determine the effectiveness of two topical piroxicam and EMLA on fistula cannulation pain intensity in hemodialysis patients. This clinical trial study was conducted on 75 patients referred to dialysis ward in Khorramabad Shohada hospital in 2013. Patients were randomly divided into three groups: group A (piroxicam), group B (EMLA) and group C (placebo). Data collection tools included demographic information, Visual Analogue Scale (VAS) and a checklist for possible side effects of the drugs. Pain intensity during fistula cannulation was measured in the three groups on two occasions, before and after the intervention. The collected data were then analyzed using Mann-Whitney and Kruskal-Wallis tests and SPSS19 software. The median pain intensity before and after the intervention in the three groups, was significantly different (p <0/001). The highest median pain intensity reduction was in the EMLA, piroxicam and placebo groups respectively. In addition, a short term side effect (blanching) in 16% of the subjects was detected in EMLA group. The results showed that EMLA cream was more effective than piroxicam gel in reducing the pain intensity of fistula cannulation in dialysis patients. Therefore, our study recommends to use EMLA cream as an easy method with ability to work by patients, to reduction pain during fistula cannulation in hemodialysis patients.