Babamohamadi Hassan, Ameri Zahra, Asadi Ilia, Asgari Mohammad Reza
Nursing Care Research Center, Semnan University of Medical Sciences, Semnan 3513138111, Iran.
Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan 3513138111, Iran.
Evid Based Complement Alternat Med. 2022 Aug 31;2022:8383021. doi: 10.1155/2022/8383021. eCollection 2022.
Pain due to vascular needle insertion has been reported in 40-60% of hemodialysis (HD) patients. Evidence suggests that there is typically no single method for relieving the pain of inserting vascular needles in HD patients. This study aimed to compare the effectiveness of EMLA cream and Valsalva maneuver (VM) on pain severity during vascular needle insertion in HD patients.
This randomized, controlled, clinical trial was conducted on 90 patients undergoing hemodialysis in the hemodialysis unit of Kowsar Hospital, affiliated with Semnan University of Medical Sciences, in Semnan, Iran. Patients were selected via convenience sampling and were randomly assigned to one of the three groups (EMLA, VM, and control groups). For the patients in the EMLA group, 2.5 g of EMLA cream was applied 60 minutes before the start of dialysis. For patients in the VM group, a maneuver was performed for 16-20 seconds before the needle was inserted. Patients in the control group received only routine care without any additional interventions. The pain severity in the three groups was measured using the visual analog scale (VAS) two minutes after vascular needle insertion.
The results showed that the mean pain severity during cannulation was 2.06 ± 2.19 in the EMLA group, 3.2 ± 30.42 in the VM group, and 6.20 ± 1.49 in the control group, suggesting a significant difference between the groups ( < 0.001). Pairwise comparison of the mean pain severity showed that it differed significantly in the EMLA and VM groups from the control group ( < 0.001), but no significant difference was found between the EMLA and VM groups (=0.067).
According to the results, EMLA cream was as effective as VM in reducing the pain severity caused by arteriovenous fistula (AVF) cannulation. Therefore, the use of EMLA cream and VM is recommended for reducing the severity of AVF cannulation pain. . Iranian Registry of Clinical Trials, Trial No : IRCT20120109008665N12, registered on 3 June 2020.
据报道，40%-60%的血液透析（HD）患者存在血管穿刺疼痛。有证据表明，通常没有单一的方法可以缓解HD患者血管穿刺的疼痛。本研究旨在比较复方利多卡因乳膏（EMLA）和瓦尔萨尔瓦动作（VM）对HD患者血管穿刺时疼痛严重程度的效果。
本随机对照临床试验在伊朗塞姆南省塞姆南医科大学附属科萨尔医院血液透析科的90例接受血液透析的患者中进行。通过便利抽样选择患者，并将其随机分配到三组之一（EMLA组、VM组和对照组）。对于EMLA组的患者，在透析开始前60分钟涂抹2.5g复方利多卡因乳膏。对于VM组的患者，在穿刺前进行16-20秒的动作。对照组患者仅接受常规护理，无任何额外干预。在血管穿刺两分钟后，使用视觉模拟量表（VAS）测量三组患者的疼痛严重程度。
结果显示，EMLA组置管期间的平均疼痛严重程度为2.06±2.19，VM组为3.2±30.42，对照组为6.20±1.49，表明三组之间存在显著差异（P<0.001）。平均疼痛严重程度的两两比较显示，EMLA组和VM组与对照组相比存在显著差异（P<0.001），但EMLA组和VM组之间未发现显著差异（P=0.067）。
根据结果，复方利多卡因乳膏在减轻动静脉内瘘（AVF）穿刺引起的疼痛严重程度方面与瓦尔萨尔瓦动作效果相同。因此，建议使用复方利多卡因乳膏和瓦尔萨尔瓦动作来减轻AVF穿刺疼痛的严重程度。伊朗临床试验注册中心，试验编号：IRCT20120109008665N12，于2020年6月3日注册。
