Rhythmic Breathing Combined with Hugo Point Acupressure versus Vapocoolant Spray on Pain Intensity during Needle Insertion into Arteriovenous Fistula in Haemodialysis Patients: A Randomised Controlled Trial

BACKGROUND: Pain from needle insertion during haemodialysis is a common challenge requiring effective pain management for patient comfort. AIMS: The aim of this study to compared rhythmic breathing combined with Hugo point acupressure versus vapocoolant spray on pain intensity during needle insertion in haemodialysis patients. SUBJECTS AND METHODS: A randomised controlled trial was conducted in Iraq between 4 December 2024 and 16 January 2025, and involved 157 patients. Participants were assigned into five groups: control (n = 34), rhythmic breathing (n = 24), Hugo point acupressure (n = 35), combination rhythmic breathing with acupressure (n = 37) and vapocoolant spray (n = 27). Pain intensity was assessed using the Visual Analogue Scale immediately following needle insertion. Data analysis was performed using SPSS. RESULTS: The control group reported the highest mean pain score (64.79), followed by rhythmic breathing (37.79), Hugo point acupressure (33.14), the combination group (28.35) and vapocoolant spray (25.59). All interventions significantly reduced pain compared with the control group (P < 0.001). The combination group was superior to rhythmic breathing or acupressure alone (P < 0.001). Vapocoolant spray was also more effective than each single intervention (P < 0.01), yet the difference between vapocoolant spray and the combination group was not significant (P > 0.05). CONCLUSIONS: The combination of rhythmic breathing and Hugo point acupressure reduced pain more effectively than either intervention alone. Although vapocoolant spray was highly effective, it did not significantly outperform the combination. Thus, the combined method provides a reliable alternative, especially for patients unable to use vapocoolant spray or in resource-limited settings.