The effect of cold packs, lidocaine spray, and flashlights on cannulation pain in patients undergoing hemodialysis: a randomized controlled trial

Abstract

Background Pain is a frequent and critical problem in daily hemodialysis practice. The pain experienced during arteriovenous fistula cannulation varies from 12% to even 80% in hemodialysis patients depending on the pain assessment tools used. Pain can lead to sleep problems, decreased compliance with hemodialysis therapy, frequent hospital hospitalizations, a decline in quality of life, and high death rates. Despite utilizing several methods as pain relief, it is still unknown in the literature and practice which method is the most effective. The purpose of the study was to compare the effect of lidocaine spray, cold packs, and flashlights on the pain induced by arteriovenous cannulation in hemodialysis patients. This was a prospective randomized open-label controlled trial. Hundred and eight adult patients on regular hemodialysis were recruited and simply randomized into one of four groups (lidocaine spray, cold packs, flashlights, and control) before cannulation. Results The mean pain severity using visual analog scale was 4.3 (3.3–5.7) in lidocaine group, 4 (3–5.7) in cold packs group, 4.3 (3.3–5.3) in flashlight group, and 4.7 (3–6) in control group. There was a borderline significant difference between groups using Kruskal–Wallis test (p = 0.054). The post hoc Tukey test showed that only cold packs differ from control group with borderline significance (p = 0.051). Conclusion The results showed that cold packs were safe and effective than lidocaine spray or flashlights in reducing cannulation pain. It is suggested to implement this method before cannulation in hemodialysis patients to reduce pain and improve quality of life. Future studies are needed to compare different application times of cold packs and its impact on pain scores to recommend the optimum time needed to achieve maximum analgesic effect. Trail registration: Clinical trials.gov NCT05822063, REC #194. Graphical abstract