![]() Currently, the United States National Kidney Foundation has developed a “Fistula First” awareness campaign regarding vascular access, which strongly recommends AVF. ![]() ![]() Furthermore, the number of patients who receive chronic maintenance hemodialysis is predicted to significantly increase worldwide. In Japan, AVF accounts for a greater proportion of vascular access than in the United States (Japan, 96.8% the United States, 55.5%), and many patients undergo hemodialysis over a long period of time due to the small number of renal transplants therefore, this issue represents an urgent problem. For patients undergoing chronic maintenance hemodialysis, the pain associated with arteriovenous fistula (AVF) punctures during each dialysis session causes a great deal of stress. The number has been increasing annually and exceeded 300,000 in 2012. Japan is the second country with the largest number of patients receiving chronic maintenance dialysis worldwide, after the United States. Trial registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN000027885). Taken together, these results suggest that EMLA cream is superior to lidocaine tape for the relief of arteriovenous fistula puncture pain in patients undergoing maintenance hemodialysis. Further, no drug-related adverse events were observed. However, there was no statistically significant difference in the quality of life between the two groups, and no significant carryover/period effect was observed in any analysis. EMLA produced a 10.1-mm greater visual analog scale improvement than lidocaine tape (P = 0.00001). The secondary endpoints included quality of life, which was measured by SF-36, and safety. The primary endpoint was puncture pain relief, which was measured using a 100-mm visual analog scale. At each puncture site, 1 g EMLA (25 mg lidocaine + 25 mg prilocaine) or one sheet of lidocaine tape (18 mg lidocaine) was applied 1 h or 30 min prior to arteriovenous fistula puncture, respectively. Subjects were assigned to Sequence EL (EMLA administration followed by lidocaine, with 1-week wash-out) or Sequence LE (reverse administration, first lidocaine then EMLA). ![]() To this end, we conducted a multicenter randomized crossover study including 66 patients (mean age, 65.8 years males, 57.6%) undergoing maintenance hemodialysis thrice/week. No previous study has compared lidocaine/prilocaine cream (EMLA) with lidocaine tape for pain relief during arteriovenous fistula puncture in patients undergoing maintenance hemodialysis. Keiji Fujimoto, Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing, 1, * Hiroki Adachi, Data curation, Investigation, Resources, 1 Keita Yamazaki, Data curation, Investigation, Resources, 2 Kanae Nomura, Data curation, Investigation, Resources, 1 Atsushi Saito, Data curation, Investigation, Resources, 3 Yuji Matsumoto, Data curation, Investigation, Resources, 4 Kazunari Igarashi, Data curation, Investigation, Software, 4 Hiroko Uranishi, Data curation, Investigation, Resources, 5 Suga Sakaguchi, Data curation, Investigation, Resources, 5 Toshikazu Matsuura, Data curation, Investigation, Resources, 1 Junko Imura, Data curation, Investigation, Resources, 6 Kazuaki Okino, Data curation, Investigation, Resources, 1 Kiyotaka Mukai, Data curation, Investigation, Resources, 1 Yuki Okushi, Data curation, Investigation, Resources, 1 Yu Kagaya, Data curation, Investigation, Resources, 2 Yuko Tsuruyama, Data curation, Investigation, Resources, 1 Keiichiro Okada, Data curation, Investigation, Resources, 1 Nobuhiko Miyatake, Data curation, Investigation, Resources, 1 Takatoshi Haraguchi, Data curation, Investigation, Resources, 3 Yasuo Iida, Data curation, Formal analysis, Methodology, Software, Supervision, Validation, Visualization, Writing – review & editing, 7 and Hitoshi Yokoyama, Methodology, Resources, Supervision, Validation, Visualization, Writing – review & editing 1Īrteriovenous fistula puncture pain is a serious problem for patients undergoing dialysis and a good indication for topical anesthetics. ![]()
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