title: Does Routine Midazolam Administration Prior to Nasogastric Tube Insertion in the Emergency Department Decrease Patients' Pain? (A Pilot Study).
abstract: Patients report pain and discomfort with nasogastric tube (NGT) intubation. We tested the hypothesis that premedication with midazolam alleviates pain during NGT placement in the emergency department (ED) by > 13 on a 100-mm visual analog scale (VAS).
  
  
  
  We performed a double-blind randomized controlled pilot study, assigning ED patients requiring NGT placement to midazolam or placebo. All patients received intranasal cophenylcaine; additionally, they received an intravenous (IV) dose of the study drug, either 2 mg of IV midazolam or saline control. Nurses placed NGTs while observed by research staff, who then interviewed subjects to determine the primary outcome of pain using a VAS. Additional data collected from patients and their nurses included discomfort during the procedure, difficulty of tube insertion, and complications.
  
  
  
  We enrolled 23 eligible patients and obtained complete data in all: 10 midazolam and 13 controls. We found a significant reduction in mean pain VAS score of -31 (95% confidence interval = -53 to -9 mm) with 2 mg of midazolam (mean ± SD = 52 ± 30 mm), compared to placebo (mean ± SD = 21 ± 18 mm), more than double the effect size considered clinically relevant. Treatment did not impact ease of placement and there were no serious adverse effects.
  
  
  
  Premedication with 2 mg of IV midazolam reduces pain of NGT insertion in ED patients without the need for full procedural sedation.
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT.
authors.forename: Chelsea Taylor
authors.initials: CT
authors.lastname: Manning
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT.
authors.forename: Jacob Dillon
authors.initials: JD
authors.lastname: Buinewicz
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT.
authors.forename: Thomas Patrick
authors.initials: TP
authors.lastname: Sewatsky
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Zgonis
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT.
authors.forename: Kathy
authors.initials: K
authors.lastname: Gutierrez
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT.
authors.forename: Michael F
authors.initials: MF
authors.lastname: O'Keefe
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT.
authors.forename: Kalev
authors.initials: K
authors.lastname: Freeman
mesh_terms: D000328:Adult; D000758:Anesthesia; D004311:Double-Blind Method; D004338:Drug Combinations; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007441:Intubation, Gastrointestinal; D008012:Lidocaine; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010656:Phenylephrine; D010865:Pilot Projects; D011292:Premedication
chemical_list: D004338:Drug Combinations; D006993:Hypnotics and Sedatives; C546419:phenylephrine, lidocaine drug combination; D010656:Phenylephrine; D008012:Lidocaine; D008874:Midazolam