Information about topical anesthetics used for dialysis

Hello - I’m trying to research what percent of hemodialysis patients use a topical anesthetic for pain management for needle injections, and of the patients that use a topical, what types of topicals do they use (e.g. EMLA, lidocaine cream, patch or spray)? Also trying to find out the percentage of patients in the U.S. that have arteriovenous fistula (AVF) or arteriovenous graft (AVG) or catheter. If anyone has such information or approximations, I would appreciate it! Thank you!

The United States Renal Data System collects and reports data on many things related to ESRD. The 2019 Annual Data Report Summary at provides data on vascular access starting on page 37. According to that document, in prevalent patients in 2017, 62.9% were using a fistula, 17.5% were using a graft and 9.1% were using a catheter after 90 days.

I’m not aware of any national data on how many HD patients use topical anesthetics. Injectable and topical anesthetics are covered under the ESRD prospective payment system for Medicare patients. Some dialysis clinics appear not to offer them or discourage their use and some patients choose not to use them. Medicare patients who do use them don’t have to buy them so there would be no record of a claim. I think it would difficult to know how many HD patients use them without conducting a survey. Even then it would be difficult to extrapolate the results from those who responded to the entire HD population.

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Hi Beth - thank you so much for your incredible insights and the helpful link to the report which was exactly the information that I needed! Do you happen to know if it is a practice for hospitals/centers to automatically use the topicals on (EMLA or lidocaine cream) on children. I heard from a pediatric doctor working at a US Children’s hospital automatically apply the topicals to children for the first several weeks or months of their dialysis treatments, but after a while (similar to adults), they don’t need to apply the topicals because they either get used to the injections or sometimes scar tissue builds up and the patient doesn’t feel the pain anymore. Do you think the build up of scar tissue or adaption to the pain are some reasons why patients don’t really use the topicals? Also have you heard of any negative reactions to healthcare professionals using tetracaine instead of EMLA or lidocaine? Thank you again for your insight and information! Kris

I haven’t ever worked in a pediatric dialysis program and don’t know what their practice is so far as using topical anesthetics. However, I have had children and know that many of them as well as adults have needle fear. I think dialysis staff may be so used to sticking people that they discount patients’ fear and some are never offered and don’t even know they could ask for a topical anesthetic. Here are 3 articles about needle fear, the second one written by a patient, and the third one I wrote years ago and included info about topical anesthetics…

Scar tissue that does develop can reduce pain. Some patients with fistulas choose to create and use “buttonholes” by sticking the same place to create a track similar to pierced earrings. Here’s an article with patient quotes about cannulation (buttonhole and rope ladder techniques).

Dialysis clinics may be unaware that they’re responsible for providing topical anesthetics under the rate they’re paid for dialysis. I’ve had to point patients and staff to the Medicare Benefit Policy Manual, Chapter 11 for this information. That said, when Medicare includes a product in the bundled payment for dialysis for Medicare beneficiaries, I always worry that there may be financial incentives to not provide that drug.

I’ve not heard anything one way or the other about tetracaine and in fact I hadn’t heard of it and had to look it up. I have heard of EMLA, lidocaine, lidocaine/prilocaine, and spray topical anesthetic. If you work for a company that makes such a product, MEI has a Helpful Products Catalog where it can be listed for free.

Thanks Bet … concur with all of the above. For US stats, the USRDS is always the first port of call, though equally or more robust national databases for international comparisons are available … for a list, and for their comparative value/robustness re data, see …

… for a complete selection of the 48 existing international renal and dialysis/transplantation registries.

Table 2 provides all registries and comparative data availability/reliability.