On average, a patient with ESRD undergoes hemodialysis three times per week. This approximates to about 320 punctures per year, with larger thick needles.

Clinical studies have indicated the varied prevalence of AVF cannulation-associated pain, ranging between 12%-80%

In one of the other studies reporting the prevalence of pain due to AVF cannulation, 57% of the patients treated with HD reported that pain due to a minimum of three site punctures per week was a major challenge. A recent study in Saudi Arabia showed that majority of patients (>90%) experienced a mild to moderate level of pain during AVF cannulation. Also, a positive association was noted between the level of pain and anxiety, with statistical significance (p<0.001)

References:

1. Ibrahim MB, Abdelaal Badawi SE, Alameri RA. Assessment of pain and anxiety during arteriovenous fistula cannulation among hemodialysis patients: A cross-sectional study in Saudi Arabia. J Multidiscip Healthc. 2022;15:705–71

2. Kosmadakis G, Amara I, Costel G. Pain on arteriovenous fistula cannulation: A narrative review. Semin Dial. 2021;34(4):275–284

3. Alzaatreh MY, Abdalrahim MS. Management strategies for pain associated with arteriovenous fistula cannulation: An integrative literature review. Hemodial Int. 2020;24(1):3–11.

Warnings and Precautions: Allergy-Allergic and anaphylactic reactions characterized by urticaria, angioedema, bronchospasm, and shock can occur. If these reactions occur they should be managed according to standard clinical practice. Methemoglobinemia is well documented in relation to Prilocaine and Lidocaine combination treatment. Patients with glucose-6-phosphate dehydrogenase deficiency or congenital or idiopathic methemoglobinemia are more susceptible to drug-induced methemoglobinemia. Lidocaine and Prilocaine Gel should not be used in those patients with congenital or idiopathic methemoglobinemia.

Ear/Nose/Throat-Lidocaine and Prilocaine Gel should not be used in clinical situations where it can penetrate or migrate into the middle ear. Care should be taken to avoid excess Lidocaine and Prilocaine from spreading to the oropharyngeal mucosa.

Other precautions: Lidocaine and Prilocaine Gel should not be applied to open wounds. Lidocaine and Prilocaine Gel coming in contact with the eye should be avoided; if eye contact occurs, immediately rinse the eye with water or saline and protect it until normal sensation returns. Patients with severe hepatic disease are at greater risk of developing toxic plasma concentrations of Lidocaine and Prilocaine.