1. SRMC&RIEMCON 2009 Guwahati
Nebulized Lidocaine Decreases
Discomfort Of Nasogastric Tube
Insertion – A Randomized Double
blinded placebo controlled trial
Dr. Srihari Cattamanchi,
Final Year Postgraduate Resident,
Department of Accident & Emergency Medicine.
Sri Ramachandra Medical College & Research Institute,
Chennai – 600116. T.N. India.

2. SRMC&RIEMCON 2009 Guwahati
Aim
• To determine whether nebulized Lidocaine
administered before Nasogastric (NG tube) insertion
significantly reduces patient discomfort.
• To determine optimal concentration (4% versus 10%)
of Lidocaine, delivered by face mask nebulizer, for
minimization of discomfort and complications and to
determine difficulty in passage of Nasogastric tube.

3. SRMC&RIEMCON 2009 Guwahati
Methods
• Design: A double-blind, placebo-controlled,
randomized clinical trial of adult patients
• Setting: ED of Sri Ramachandra Medical College &
Research Institute, a tertiary care university hospital
in Chennai, S.India
• Duration: over a period of 2 months from October
1st 2008 to September 30th 2009.
• Instrument: A pre-formatted Proforma was an
instrument in the study.

4. SRMC&RIEMCON 2009 Guwahati
Methods Cont…
• Inclusion Criteria: All patients above 18 years of
age and requiring NG tube insertion in the ED were
included in the study.
• Exclusion Criteria: Patients with history of asthma
or airway obstructive disease, & GCS < 15 were
excluded.

5. SRMC&RIEMCON 2009 Guwahati
Methodology
• Patients randomly pretreated with 10% nebulized
Lidocaine 4 mL, 4% nebulized Lidocaine 4 mL or
normal saline 4 mL in a double-blind manner.
• NG tube was inserted immediately after completion of
treatment, using lubricating 2% Lidocaine jelly
adequately.
• SRU Ethics Committee approval was obtained.
• Informed conset was obtained from the patient and
relatives before being including in the study.

6. SRMC&RIEMCON 2009 Guwahati
Methodology
• Patient discomfort was measured with visual
analog scale.
• Insertion doctor indicated difficulty of NG
tube insertion using a 5-point Likert scale.
• Complications were recorded.

7. SRMC&RIEMCON 2009 Guwahati
Results
• A total of 86 patients were included, among them
69% were males (n=59).

8. SRMC&RIEMCON 2009 Guwahati
Fig. 1. Age & Sex Distribution

9. SRMC&RIEMCON 2009 Guwahati
Fig. 2. Indication for NG Tube Insertions

10. SRMC&RIEMCON 2009 Guwahati
Fig. 3. Distribution of patients

11. SRMC&RIEMCON 2009 Guwahati
Results..
Scales
10%
Nebulized
Lignocaine
4%
Nebulized
Lignocaine
Normal Saline
(Placebo)
Mean Visual
Analog pain
Scale
3.15 3.26 8.25
Mean Likert’s
Scale
3.56 4.21 3.10

12. SRMC&RIEMCON 2009 Guwahati
Results
• There was no difference in difficulty with
passage of Nasogastric tube between all 3
groups.
• Epistaxis occurred 3 patients in 10% nebulized
Lidocaine group.

13. SRMC&RIEMCON 2009 Guwahati
Limitations
• Nasal polyps, Carcinoma.
• Comatose & uncooperative patients.

14. SRMC&RIEMCON 2009 Guwahati
Conclusion
• Nebulized Lidocaine decreases discomfort of
Nasogastric tube insertion.
• An increased frequency of epistaxis, however, may be
associated with use of 10% Lidocaine Nebulization.
• Lidocaine Nebulization (4%, 4 mL) is associated with
less adverse effects and decreased discomfort while
passing Nasogastric tube and should be considered
before passing a nasogastric tube.

15. SRMC&RIEMCON 2009 Guwahati
Benefits
• Decreases discomfort and pain in Nasogastric
tube insertion.

16. SRMC&RIEMCON 2009 Guwahati
References
• Gallagher EJ. Nasogastric tubes: hard to swallow.
Ann Emerg Med 2004:44:138-41.
• Wolfe TR, Fosnocht DE, Linscott nasogastric tube
placement: a randomized double-blind, placebo-
controlled trial. Ann Emerg Med. 2000;35:421-425.
• Singer AJ, Richman PB, Kowalska A, et al. Ann
Emerg Med. 1999;33:652-658

17. SRMC&RIEMCON 2009 Guwahati
Thank You

18. SRMC&RIEMCON 2009 Guwahati
My Friend & Co-author