Efficacy of Lidocaine Spray in Decreasing Pain of Nasogastric Tube Insertion
Lidocaine spray is effective in significantly reducing pain associated with nasogastric tube insertion when used in combination with lidocaine jelly lubrication compared to lubricant alone. 1
Evidence for Lidocaine Use in NGT Insertion
- Lidocaine spray plus lidocaine jelly lubrication significantly reduces pain during nasogastric tube insertion compared to lidocaine jelly lubrication alone (pain scores 23.6 ± 16.6 vs. 43.1 ± 31.4 mm on visual analog scale) 1
- Topical 2% lidocaine gel administered nasally 5 minutes before NGT insertion significantly reduces overall pain (37 ± 28 mm vs 51 ± 26 mm) and nasal pain (33 ± 29 mm vs 48 ± 27 mm) compared to lubricant gel 2
- Lidocaine nasal drops (2%) instilled 3 minutes before the procedure significantly reduce pain scores compared to saline drops (1.41 ± 0.50 vs. 4.54 ± 1.03) and decrease procedure duration (1.52 ± 0.76 min vs. 3.38 ± 1.36 min) 3
- Nebulized lidocaine (4 mL 10%) before NGT insertion significantly reduces patient discomfort compared to nebulized saline (mean VAS score 37.7 vs. 59.3 mm) 4
Administration Methods and Timing
- For optimal effect, apply lidocaine spray to the nostril and throat prior to NGT insertion, followed by lubrication of the tube with lidocaine jelly 1
- Allow 3-5 minutes after application of topical lidocaine before attempting NGT insertion for maximum anesthetic effect 2, 3
- Topical anesthetics require a wait time of 5-10 minutes (depending on type) to achieve adequate anesthesia 5
Potential Benefits Beyond Pain Reduction
- Reduced gagging sensation during NGT insertion (25 ± 30 mm vs 39 ± 24 mm on VAS) 2
- Higher patient satisfaction with 93% of patients favoring lidocaine spray for future NGT insertions versus 65% in placebo group 1
- Increased physician satisfaction with the procedure when lidocaine is used 1
- Higher first-attempt success rates (98% with lidocaine nasal drops vs. multiple attempts needed with saline) 3
- Reduced incidence of complications such as vomiting, coughing, and difficult breathing 3
Potential Drawbacks and Side Effects
- Nebulized lidocaine may be associated with increased frequency of epistaxis (17% versus 0% with placebo) 4
- Some studies report more difficult tube insertion with lidocaine gel compared to lubricant gel alone 2
- Patients should be warned of self-limiting side effects of intravascular lidocaine, such as numbness of the tongue or tinnitus 5
Recommended Approach
- Apply 10% lidocaine spray to nostril and throat prior to NGT insertion 1
- Lubricate the NGT with 2% lidocaine jelly 1
- Wait 3-5 minutes before attempting insertion 2, 3
- Monitor for potential side effects including epistaxis and signs of systemic absorption 4
This approach provides the best balance of pain reduction and procedural success while minimizing potential complications.