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). Conclusion: 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.