What is the best topical anesthetic for nasogastric insertion? A comparison of lidocaine gel, lidocaine spray, and atomized cocaine.
BACKGROUND
Nasogastric intubation has been shown to be a painful procedure for patients. Previous studies have demonstrated the benefit of topical nasal anesthesia in decreasing the pain of this procedure. This study attempts to identify which of 3 topical anesthetic modalities would be preferred by patients.


METHODS
This study had a double-blind, double-dummy randomized triple crossover design with 30 healthy volunteers as participants. Each participant had 3 nasogastric tubes inserted and acted as his or her own control for the 3 study medications: 1.5 mL 4% atomized lidocaine, 1.5 mL 4% atomized cocaine, and 5 mL 2% lidocaine gel. Participants scored pain of tube passage through the nostril as well as global discomfort. They were also asked to identify which agent they preferred.


RESULTS
In our 30 subjects, although no statistically significant difference in nasal pain scores was found, "global discomfort" was less with the lidocaine gel (P =.017). Participants preferred the lidocaine gel over atomized cocaine (P <.00), but not to a statistically significant degree.


CONCLUSIONS
Two percent lidocaine gel appeared to provide the best option for a topical anesthetic during nasogastric tube insertion.
Department of Emergency Medicine, Saint John Regional Hospital, New Brunswick, Canada.
James
J
Ducharme
Kim
K
Matheson
D000281:Administration, Intranasal; D000287:Administration, Topical; D000779:Anesthetics, Local / Q000008:administration & dosage*; D003042:Cocaine / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005782:Gels; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage*; D009330:Nebulizers and Vaporizers; D010147:Pain Measurement; D017060:Patient Satisfaction
D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine; D003042:Cocaine