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Using cryotherapy, <scp>EMLA</scp> (eutectic lidocaine/prilocaine) cream, or lidocaine spray to reduce pain during arteriovenous fistula puncture: A randomized controlled trial
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Abstract<sec><title>Introduction

In hemodialysis patients, pain associated with needle insertion into an arteriovenous fistula is a physical and psychological problem. The aim of this study was to assess the effectiveness of pre‐puncture application of an ice pack, EMLA cream, or lidocaine spray to reduce pain associated with access puncture.

Methods

This was a multicenter study done in nine hemodialysis centers in Iraq. The study utilized a randomized, parallel‐group design, in which patients being dialyzed using an arteriovenous access were allocated into one of four groups. Access puncture was preceded by nothing (control group), by use of ice pack cooling at the puncture site, by application of EMLA cream, or by application of lidocaine spray. Pain after access puncture was assessed during a single treatment for each patient. Pain was quantified using a Visual Analogue Scale.

Findings

A total of 1548 patients agreed to participate, and 1041 patients were included in the data analysis. Use of an ice pack, EMLA cream, or lidocaine spray each was associated with a lower pain score on access puncture compared with no pretreatment. The mean Visual Analogue Scores in the four groups were: 69.7 ± 15.7 in the controls, 39.8 ± 13.2 in the ice pack group, 45 ± 18.4 in the EMLA group, and 52.9 ± 15.2 in lidocaine group. Ranking of the pain severity scores suggested that ice pack use was associated with the least pain, followed by use of EMLA cream and use of lidocaine spray (severity score ranking, from lowest to highest, being 1.62, 2.18, and 2.63, respectively).

Discussion

Application of an ice pack prior to vascular access puncture is a fast and inexpensive technique to limit pain associated with this procedure.

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Mon Jan 02 2012
Journal Name
Journal Of The Faculty Of Medical Baghdad
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Indian Journal Of Forensic Medicine & Toxicology
Evaluation of nurses’ knowledge and attitudes toward pain management at Baghdad Teaching Hospitals
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Sun Nov 09 2025
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Journal Of Babylon Center For Humanities Studies
The motives of pain in the play (Bells and Trains) by Yehuda Amichai
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The upbringing of Yehuda Amichai and the conditions he lived in had a great influence on his deep sense of pain, which made him think of death and suicide. Especially after the Nazis came to power in Germany, and his emigration with his family. Amichai searched for love throughout his life, and his failure was one of the most important factors affecting his psyche, which is A deep influence that made him live in harsh and painful pains that broke him, and prevented her from achieving his ambitions in life.Dramatic texts are characterized by repetition in writing and presentation. It is a textual discourse that has two advantages, first, that it can be read as a literary text like all other literary texts, and second, that it can be consider

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Tue Mar 01 2022
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Academy Of Accounting And Financial Studies Journal
Impact of Digital Audit on Improving performance Quality and Reduce Costs An applied research in a sample of private auditing firms and offices
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Colloids And Surfaces A: Physicochemical And Engineering Aspects
Application of natural deep eutectic solvents in bulk liquid membrane system for removal of free glycerol from crude fatty acid methyl ester
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Fatty Acid Methyl Ester (FAME) produced from biomass offers several advantages such as renewability and sustainability. The typical production process of FAME is accompanied by various impurities such as alcohol, soap, glycerol, and the spent catalyst. Therefore, the most challenging part of the FAME production is the purification process. In this work, a novel application of bulk liquid membrane (BLM) developed from conventional solvent extraction methods was investigated for the removal of glycerol from FAME. The extraction and stripping processes are combined into a single system, allowing for simultaneous solvent recovery whereby low-cost quaternary ammonium salt-glycerol-based deep eutectic solvent (DES) is used as the membrane phase.

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Publication Date
Wed Jan 30 2019
Journal Name
Journal Of The College Of Education For Women
Taboo Words Vs. Social Deixis: A sociolinguistic Analysis of La Justice or The Cock that Crew: A Play from the Theatre of Ridiculous
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Linguistic taboos exist in most cultures. Tabooed words are generally being culturespecific
and relating to bodily functions or aspects of a culture that are sacred. Such words are
avoided, considered inappropriate and loaded with affective meaning and failing to adhere to.
Strict rules, often, governing their use and lead to punishment or public shame. These taboo
words can be used as a way of violating social deixis represented by four types of honorifics;
addressee, referent, bystander, and finally setting honorifics. This paper shows how these
taboo words are used in Kenneth Bernard's play La Justice or The Cock that Crew from the
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Publication Date
Tue Jan 01 2019
Journal Name
Journal Of Global Pharma Technology
Synthesis and characterization of chitosan schiff base hydrogel for controlled drug release
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Chitosan-schiff base with three different ratios of para-Dimethyl aminobenzaldehyde& chitosan Schiff base hydrogels have been prepared for controlled drug release study. The synthesized chitosan Schiff base and chitosan Schiff base hydrogel were characterized by FT-IR, UV-Visible, SEM, analysis. Swelling properties of the hydrogel were investigated at three different media pH (2, 7, 10). The swelling degree varied with the pH, amount of crosslinking agent glutaraldehyde and with the amount of paraDimethylaminobenzaldehyde for the hydrogels. All hydrogels were used for controlled drug release system. Aspirin was used as model drug, in three different buffer solution (2, 7, 10) as release media. The rate of release of drugs in the pH2 is m

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Publication Date
Fri Oct 01 2010
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Iraqi Board For Medical Specializations In Dermatology And Venereology
Treatment of Cutaneous Leishmaniasis by Topical 25% Podophyllin Solution (Case-Controlled Study)
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Sun Nov 09 2025
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The value of ultrasound and color Doppler ultrasonography in the evaluation of periapical lesions in comparison to histopathological and/or surgical findings
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Background: Imaging techniques play a very important role in the specialty of endodontic. The ultrasonographic technique is non-expensive procedure, safe, and reproducible. The aim of the study was to determine the sensitivity, specificity, and accuracy of ultrasound and color Doppler ultrasonography in evaluation of periapical lesions (cyst, granuloma, mixed lesion “cyst within graulomas mass”, and abscess. Subject, Material and method: The sample consists of prospective study for 64 Iraqi participants who attended Karbalaa Specialized Center for Dentistry (males & females). Those patients were diagnosed clinically and radiographically as having periapical lesions of dental origin. They were examined by real time ultrasound and color

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