Lidocaine gel as an anesthetic protocol for nasogastric tube insertion in the ED.
OBJECTIVE
The aim of the study was to evaluate the efficacy of topical 2% lidocaine gel in reducing pain and discomfort associated with nasogastric tube insertion (NGTI) and compare lidocaine to ordinary lubricant gel in the ease in carrying out the procedure.


METHODS
This prospective, randomized, double-blind, placebo-controlled, convenience sample trial was conducted in the emergency department of our tertiary care university-affiliated hospital. Five milliliters of 2% lidocaine gel or placebo lubricant gel were administered nasally to alert hemodynamically stable adult patients 5 minutes before undergoing a required NGTI. The main outcome measures were overall pain, nasal pain, discomfort (eg, choking, gagging, nausea, vomiting), and difficulty in performing the procedure. Standard comparative statistical analyses were used.


RESULTS
The study cohort included 62 patients (65% males). Thirty-one patients were randomized to either lidocaine or placebo groups. Patients who received lidocaine reported significantly less intense overall pain associated with NGTI compared to those who received placebo (37 ± 28 mm vs 51 ± 26 mm on 100-mm visual analog scale; P < .05). The patients receiving lidocaine also had significantly reduced nasal pain (33 ± 29 mm vs 48 ± 27 mm; P < .05) and significantly reduced sensation of gagging (25 ± 30 mm vs 39 ± 24 mm; P < .05). However, conducting the procedure was significantly more difficult in the lidocaine group (2.1 ± 0.9 vs 1.4 ± 0.7 on 5-point Likert scale; P < .05).


CONCLUSIONS
Lidocaine gel administered nasally 5 minutes before NGTI significantly reduces pain and gagging sensations associated with the procedure but is associated with more difficult tube insertion compared to the use of lubricant gel.
Uri
Ofir
O
Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel. ofiruri@gmail.com
Yosefov
Lior
L
Haim
Amir
A
Behrbalk
Eyal
E
Halpern
Pinchas
P
D000281:Administration, Intranasal; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002482:Cellulose / Q000031:analogs & derivatives / Q000627:therapeutic use; D015331:Cohort Studies; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D005782:Gels; D005990:Glycerol / Q000627:therapeutic use; D006801:Humans; D007322:Instillation, Drug; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D008012:Lidocaine / Q000627:therapeutic use*; D054327:Lubricants / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000517:prevention & control*; D010710:Phosphates / Q000627:therapeutic use; D011409:Propylene Glycols / Q000627:therapeutic use; D016896:Treatment Outcome
D000779:Anesthetics, Local; D005782:Gels; C042973:K-Y jelly; D054327:Lubricants; D010710:Phosphates; D011409:Propylene Glycols; D002482:Cellulose; D008012:Lidocaine; D005990:Glycerol