Nasogastric tube (NGT) placement is a painful procedure. Despite the pain involved, this procedure is routinely done without analgesia or topical anesthesia. Wolfe and associates used a randomized, double-blind, placebo-controlled trial to assess the pain of NGT placement after the intranasal and oropharyngeal application of an atomized solution of 4 percent lidocaine or placebo.

Forty patients were enrolled in the study. A solution of 1.5 mL was atomized into the nasopharynx, and 3 mL was atomized into the oropharynx and swallowed. Atomization was performed with a disposable mucosal atomization device. All patients in both arms of the study had 5 mL of 2 percent lidocaine jelly injected into the nostril selected for the NGT. The total dosage of lidocaine in patients receiving the atomized and jelly preparations was 280 mg compared with 100 mg in patients receiving only the jelly. Immediately after the procedure, patients were asked to rate the pain experienced during the procedure on a graphic pain scale.

There was a significant difference in the pain scores noted by the patients in the study, with patients in the lidocaine group reporting significantly less pain during the procedure. There were no inadvertent tracheal intubations in either study group.

The authors concluded that the pain of NGT placement can be significantly reduced by preapplication of topical atomized 4 percent lidocaine immediately before tube insertion.