Impacto da analgesia na punção de fístula arteriovenosa durante hemodiálise

Abstract

Currently, chronic kidney disease is considered a global public health issue, affecting millions of people. In Brazil, the main treatment of choice is Hemodialysis, which requires vascular access; arteriovenous fistula being its best and most effective access. The moment of puncture of the arteriovenous fistula has been reported as something painful by the patients. Knowing that pain is something of a subjective nature, we need tools to evaluate its intensity, and through this measurement to provide appropriate therapeutics for its control. Objectives: To evaluate the intensity of pain at the time of puncture of the arteriovenous fistula and assess whether the use of topical anesthetic and placebo can trigger interference in the intensity of this pain. Method: This is a prospective cross model experimental study; two instruments were applied to sixty-two (62) patients who underwent Hemodialysis with arteriovenous fistula as vascular access in two Renal Replacement Therapy Units in the interior of São Paulo state. The first instrument was a sociodemographic and clinical questionnaire that was delivered at the beginning of the study, which could be returned until the end of the research. The second instrument was a visual analogue scale to measure pain; it was fulfilled after puncturing the arteriovenous fistula, during three different moments (without the use of anesthetic, with the use of anesthetic and with the use of placebo). Patients with cognitive and visual deficits were excluded, which made it impossible to fulfill the scale for measuring pain. Data were submitted to Komolgorov-Smirnov normality tests, Mann-Whitney statistical tests and Spearman and Friedman correlation tests. Results: The painful experience caused by the puncture of the arteriovenous fistula appeared as significant suffering with a 4.19-average pain intensity. The use of the topical anesthetic of choice proved to be effective providing a drop in pain intensity level of 52.74%; placebo showed a lower result than the anesthetic, but still positive, with a drop of 28.88% in pain intensity. In relation to the sociodemographic and clinical characteristics, data have not presented significant correlations, but showed trends in relation to factors such as sex, age, time of arteriovenous fistula, and whether the person who punctures interferes with the pain. The contributions of this research are relevant to clinical practice, since the painful experience caused by the puncture of the arteriovenous fistula presents a significant suffering for the patient on Hemodialysis. Conclusion: The use of anesthetic proved to be effective, providing a drop in the level of pain intensity, while the placebo showed a lower result than the anesthetic, but still being positive, demonstrating that the emotional issue also interferes with pain intensity. This theme is little approached in scientific studies, being the pain sub-treated. This hinders compliance to treatment and fosters a drop in the quality of life of these patients. Measuring and treating pain is always a challenge, but it is also something essential so that we can give these patients a humanized and a high-quality assistance.