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ABSTRACT INTRODUCTION Pain is one of the most frequent complaints of patients during Arterio-venous fistula vein puncture. Pain inflicted by insertion of large cannula into Arterio-venous fistula on regular hemodialysis is a significant cause of concern for both children and adult patients. Pain is unpleasant sensory and emotional experience associated with actual or potential damage of tissue with physiological or psychological responses. The aim of the study is to compare the effectiveness of selected Topical Anesthetic agent versus Cutaneous stimulation on level of pain at AV Fistula puncture site in patients undergoing Hemodialysis in selected hospitals of a Metropolitan city. OBJECTIVES: The objectives of this study were: 1- To compare the pain scores of patients during AV Fistula puncture between Topical anesthetic agent and Cutaneous stimulation groups. 2- To elicit opinion from pt. undergoing Hemodialysis about effect of Topical Anesthetic agent vs cutaneous stimulation on pain during AV Fistula cannulization. 3- To associate the physiological variables with pain scores in pt. undergoing dialysis using Topical anesthetic agent and Cutaneous stimulation groups. METHODOLOGY: In this study, a Quasi Experimental Non-equivalent 2 group research design was used to recruit hemodialysis patients undergoing AV Fistula puncture. Based on the selection criteria 74 patients were conveniently assigned into two groups, experimental group 1 (n=37) and experimental group 2 (n=37) from AKD units of multispecialty hospitals. On the day of hemodialysis during AV Fistula puncture, the experimental 1 group was provided with the application of Topical anaesthetic agent (Prilocaine and Lidocaine) prior 30 minutes of AV Fistula puncture and Cutaneous stimulation (application of ice pack done on the web between the thumb and index finger of the hand having AV Fistula) prior 10 minutes of AV Fistula puncture in Experimental group 2. This intervention was continued for three consecutive dialysis sessions in each experimental groups. RESULT- Comparison of average of total pain score in each groups was taken, it is found that for topical anesthetic mean pain score was more (10.06) with standard deviation (SD) 1.07, as compared with the cutaneous stimulation group where the mean pain score was (9.49) with standard deviation (SD) was 1.33. When both averages were analyzed by Mann Whitney U test, calculated value was 0.009. As both the interventions are not making any changes in the physiological parameters both can be used as an intervention in reducing pain in AV fistula puncture. The subjects strongly agreed to the fact that Cutaneous stimulation is more effective in reducing AV fistula puncture pain as compared to Topical anesthetic agent. CONCLUSION- The present study aimed to examine the effect of Topical anesthetic agent vs cutaneous stimulation on reducing the level of pain during Arteriovenous Fistula puncture among Hemodialysis patients. The findings of the study show that even modest difference in pain reduction is also important in management of pain. Both the interventions will reduce pain and improve the quality of life which includes the stability in physiological, psychological and life style aspects. As Cutaneous stimulation is found to be a non-pharmacological, cost effective and time saving intervention, so it can be used as an alternative therapy and independent nursing intervention to ease the level of pain in AV Fistula puncture in patients undergoing hemodialysis.