Atomized Lidocaine as Topical Anesthesia for Nasogastric Tube Placement: A Randomized, Double-Blind, Placebo-Controlled Trial

Study objective: To evaluate the efficacy of topical atomized 4% lidocaine in reducing the pain associated with nasogastric tube (NGT) placement. Methods: This prospective, randomized, double-blind, placebo-controlled trial was conducted in the emergency department of a university teaching hospital. Study participants were alert, hemodynamically stable adult patients requiring NGT placement for diagnostic or therapeutic purposes. Atomized 4% lidocaine or normal saline solution was administered in the nasopharynx and oropharynx before NGT placement. All patients also received topical 2% lidocaine jelly intranasally after atomization. The pain of NGT placement was measured using a standard 100-mm visual analog scale. Results: A total of 40 patients were enrolled in the study, with 20 in the lidocaine group and 20 in the placebo group. Mean pain scores were 37.4 mm (95% confidence interval [CI] 25.4 to 49.4) for atomized lidocaine and 64.5 mm (95% CI 51.8 to 77.1) for placebo with a mean difference of 27.1 mm (95% CI 14.8 to 39.4), achieving both clinical and statistical significance. Conclusion: Atomized nasopharyngeal and oropharyngeal 4% lidocaine results in clinically and statistically significant reductions in pain during NGT placement. [Wolfe TR, Fosnocht DE, Linscott MS. Atomized lidocaine as topical anesthesia for nasogastric tube placement: a randomized, double-blind, placebo-controlled trial. Ann Emerg Med. May 2000;35:421-425.]