Lidocaine/Prilocaine Cream for Cannulation in ESRD Patients

Safety and Efficacy

• The American Society of Nephrology recommends the use of lidocaine/prilocaine cream (EMLA) for cannulation in ESRD patients, as it provides significant pain relief with minimal systemic absorption and hepatic metabolism, according to the Mayo Clinic Proceedings 1
• The use of EMLA is safe in renal failure, as lidocaine and prilocaine metabolism occurs primarily in the liver, not the kidneys, and plasma levels from topical application are 100 times lower than those associated with toxicity, as stated by the Journal of the American Geriatrics Society (JAGS) 2

Pharmacokinetic Safety

• The National Kidney Foundation notes that hemodialysis clearance of lidocaine is negligible, confirming that renal elimination is not the primary route, and EMLA can be used without dose adjustment in ESRD patients, as recommended by the Mayo Clinic Proceedings 1

Practical Application

• The American College of Physicians suggests applying EMLA at least 1 hour before cannulation under occlusive dressing for optimal analgesia, and monitoring for local skin reactions, which are typically transient, as advised by the Journal of the American Geriatrics Society (JAGS) 2