1Hemodialysis Room, Kangnam St. Mary's Hospital. Catholic University 2Kangnam St. Mary's Hospital. Catholic University 3Hemodialysis Room, Kangnam St. Mary's Hospital. Catholic University 4Hemodialysis Room, Kangnam St. Mary's Hospital. Catholic University 5Hemodialysis Room, Kangnam St. Mary's Hospital. Catholic University 6Hemodialysis Room, Kangnam St. Mary's Hospital. Catholic University 7Hemodialysis Room, Kangnam St. Mary's Hospital. Catholic University 8Hemodialysis Room, Kangnam St. Mary's Hospital. Catholic University 9Hemodialysis Room, Kangnam St. Mary's Hospital. Catholic University
Abstract
This study was conducted to compare the severity of cannulation pain in hemodialysis patients after topical application of EMLA cream and local injection of lidocaine and evaluated side effects and problems accompanied by the former. Twenty patients, who were on hemodialysis from September 1 to October 15, 1994 at the Kangnam St. Mary's Hospital, Catholic University Medical College, were divided into two groups of ten. To conduct a cross over study, two groups were placed on four repeated methods with lidocaine followed by four repeated methods with EMLA cream and vice versa, respectively, while the severity of cannulation pain was being measured according to a Visual Analogue Scale with each methods. The results are follows : 1) The scale of pain was recorded as $4.56{pm}1.38$ and $2.05{pm}1.36$ points for methods with lidocaine and EMLA cream, respectively, indicating the less severe pain with EMLA cream. 2) Local side effects such as itching(4 cases, 5.0%)and pallor (5 cases, 6.3%)were observed with methods with EMLA cream but disappeared before the completion of hemodialysis. 3) Problems associated with local lidocaine were pain at the injection of anesthetic (27cases, 16.9%)and fear for needle insertion(6 cases, 3.8%). The most frequent problems with EMLA cream application were an inconvenience in use (11 cases, 6.9%)and tedious long pretreatment time(11 cases, 6.9%), those associated with inconvenience in cream applying procedures. 4) Twelve out of twenty patients(60.0%) responded with yes to a continued use of EMLA cream in spite of problems with cream application and economical difficulties in purchasing. These results indicate that 5% EMLA cream used as a local anesthetic in hemodialysis significantly reduces cannulation pain and lacks side effects, thus serving as a suitable method for the alleviation of cannulation pain and inconvenience in hemodialysis and the relief of psychological stress of nurses.
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