Department of Nephrology, Dialysis and Renal Transplantation, Ibn Rochd University Hospital; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Casablanca, Morocco.
Saudi J Kidney Dis Transpl. 2020 May-Jun;31(3):597-603. doi: 10.4103/1319-2442.289446.
Pain at arteriovenous fistula (AVF) puncture is common in hemodialysis (HD) patients. The purpose of our work is to determine its frequency, to evaluate the efficiency of two techniques: anesthetic cream (Emla™) and cryotherapy, and to compare their efficiency. A prospective and interventional analytical study of HD patients was conducted in our structure. We included all patients with pain at AVF puncture. We evaluated the pain intensity using a visual analogue scale before and after our intervention: Emla™ cream during three consecutive HD sessions, then cryotherapy (ice cubes placed in latex gloves, during 5 min, directly applied on the puncture sites) during three consecutive HD sessions. The statistical analysis was performed using the Epi Info software. Eighty-four patients are undergoing HD in our structure, of which 32 (38%) report pain at AVF puncture. The mean value of the visual analog scale before the puncture was 7.19 ± 1.95 (4-10). Pain decrease was statistically significant for both techniques. Comparative analysis of the two techniques revealed a significant reduction in pain in favor of cryotherapy (P 0.001). The analgesic effect has been proved for both techniques. Cryotherapy provides higher efficiency, with fewer constraints, and could be proposed for the management of pain at AVF puncture.
动静脉瘘（AVF）穿刺疼痛在血液透析（HD）患者中很常见。我们的工作目的是确定其频率，评估两种技术（麻醉乳膏（Emla™）和冷冻疗法）的效果，并比较它们的效率。在我们的机构中进行了一项前瞻性和干预性分析性研究，纳入了所有 AVF 穿刺疼痛的 HD 患者。我们使用视觉模拟量表在干预前后评估疼痛强度：在连续 3 次 HD 治疗中使用 Emla™乳膏，然后在连续 3 次 HD 治疗中使用冷冻疗法（将冰块放在乳胶手套中，直接应用于穿刺部位 5 分钟）。统计分析使用 Epi Info 软件进行。我们机构中有 84 名患者正在接受 HD 治疗，其中 32 名（38%）报告 AVF 穿刺疼痛。穿刺前视觉模拟量表的平均值为 7.19 ± 1.95（4-10）。两种技术都能显著降低疼痛程度。两种技术的对比分析显示，冷冻疗法在减轻疼痛方面更有效（P<0.001）。两种技术均具有镇痛效果，冷冻疗法具有更高的效率，限制更少，可用于管理 AVF 穿刺疼痛。
