title: Reducing the pain of nasogastric tube intubation with nebulized and atomized lidocaine: a systematic review and meta-analysis.
abstract: Nasogastric tube (NGT) intubations occur frequently in clinical practice and can be a painful procedure for patients. A systematic review of current knowledge concerning the use of nebulized lidocaine to reduce the pain of NGT insertion was conducted in order to develop evidence-based guidelines. In addition, a meta-analysis of appropriate randomized controlled trials (RCTs) was performed. The databases included PubMed (1996-2009), ProQuest (1982-2009), CINAHL (1982-2009), and the Cochrane Central Register of Controlled Trials (2009), and reference lists of articles. Experts in this field also were contacted. Two investigators selected the research based on inclusion criteria and reviewed each study's quality according to the Jadad scale. Five RCTs with 212 subjects were identified. A total of 113 (58%) subjects were women. The mean age of treatment and control groups was 59.6 and 55 years, respectively. The countries of studies were the United States, United Kingdom, Australia, Canada, and Thailand. In the treatment groups, the use of lidocaine concentration was 4% and 10%. The pooled effect size was 0.423 (95% confidence interval: 0.204-0.880; Z=-2.301; P=0.021), indicating that the use of nebulized lidocaine before NGT insertion can decrease pain by 57.7%. There is insufficient evidence to recommend the dosage, concentration, or delivery method. Further research is needed to articulate a comprehensive clinical guideline.
authors.affiliation: Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
authors.forename: Ya-Wen
authors.initials: YW
authors.lastname: Kuo
authors.forename: Miaofen
authors.initials: M
authors.lastname: Yen
authors.forename: Susan
authors.initials: S
authors.lastname: Fetzer
authors.forename: Jiann-Der
authors.initials: JD
authors.lastname: Lee
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine