Comparison of EMLA cream with piroxicam gel for reducing pain associated with needling of arteriovenous fistula during haemodialysis

For people on regular haemodialysis (kidney dialysis), needles must be inserted into an arteriovenous fistula — a surgically created connection between an artery and vein in the arm — at each session. This needle insertion is painful and can be a source of significant distress. This study compares two topical creams applied to the skin before needling: EMLA cream (a combination of prilocaine and lignocaine) versus piroxicam gel (an anti-inflammatory). Both are applied one hour before the dialysis session to reduce pain during the procedure. Participants receive both treatments at different sessions in a crossover design, so each person experiences both options without knowing which they are receiving at any given time. Pain is measured using a visual analog scale immediately after needling. Researchers hypothesise that EMLA cream will be more effective than piroxicam gel. You may be eligible if you have end-stage kidney disease, are on haemodialysis using a native arteriovenous fistula in your arm, and are between 18 and 75 years old. You would not be eligible if you have wounds or ulcers at the fistula site, known nerve damage that reduces pain sensation, atopic dermatitis, or allergies to either of the medications being tested.