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Tongyoo A, Thangthong T, Liwattanakun A, Sriussadaporn E, Limpavitayaporn P, Mingmalairak C. Effectiveness of Lidocaine nasal drops versus placebo drops for reducing the discomfort of nasogastric tube insertion: a randomized controlled trial study. Surg Today 2024; 54:591-595. [PMID: 37991588 DOI: 10.1007/s00595-023-02768-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/27/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE Nasogastric tube (NGT) insertion can be painful and distressing for the patient. Lidocaine nasal drops might be effective as a local anesthetic agent before the procedure. This study aimed to compare the effects of Lidocaine nasal drops versus placebo drops for reducing the discomfort of this procedure. METHODS Patients indicated for NGT insertion were categorized into two groups randomly. The Lidocaine group had 2% Lidocaine instilled nasally 3 min before the procedure and the control group had normal saline drops instilled. We compared the pain scores (using a visual analog scale) and complications between the two groups. RESULTS A total of 126 patients who required NGT insertion between September, 2021 and August, 2022 were enrolled in this study. The pain score of the Lidocaine nasal drops group was 1.41 ± 0.50 (range 1-2) and that of the control group was 4.54 ± 1.03 (range 3-7) (p < 0.01). The duration of the procedure in the Lidocaine and control groups was 1.52 ± 0.76 min and 3.38 ± 1.36 min, respectively (p < 0.01). The insertion was completed successfully within the first attempt in 98% of the Lidocaine group patients, whereas two or three attempts were needed in the control group. The incidence of complications such as vomiting, coughing, difficult breathing, and aspiration was lower in the Lidocaine group than in the control group (p < 0.01). CONCLUSION Instilling Lidocaine nasal drops before NGT insertion alleviated discomfort and reduced procedure-associated complications.
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Affiliation(s)
- Assanee Tongyoo
- Department of Surgery, Faculty of Medicine, Thammasat University, Khlong Nueng, Thailand.
| | - Tuadpong Thangthong
- Department of Surgery, Faculty of Medicine, Thammasat University, Khlong Nueng, Thailand
| | - Aekkaphod Liwattanakun
- Department of Surgery, Faculty of Medicine, Thammasat University, Khlong Nueng, Thailand
| | - Ekkapak Sriussadaporn
- Department of Surgery, Faculty of Medicine, Thammasat University, Khlong Nueng, Thailand
| | - Palin Limpavitayaporn
- Department of Surgery, Faculty of Medicine, Thammasat University, Khlong Nueng, Thailand
| | - Chatchai Mingmalairak
- Department of Surgery, Faculty of Medicine, Thammasat University, Khlong Nueng, Thailand
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Effectiveness of Positioning in Unconscious Adults During Nasogastric Intubation on Correct Placement and Intubation Time. Gastroenterol Nurs 2022; 45:395-406. [DOI: 10.1097/sga.0000000000000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/24/2022] [Indexed: 11/26/2022] Open
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Afsharjoo H, Mahmoodpoor A, Shahsavarinia K, Rahmani F. Feasibility of Nasogastric Tube Insertion in Conscious Patients: Conventional Method vs. SORT Method. Anesth Pain Med 2020; 10:e103747. [PMID: 32944564 PMCID: PMC7472647 DOI: 10.5812/aapm.103747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background Nasogastric tube (NGT) insertion is one of the most common procedures in the Emergency Department (EDs). Objectives This study aimed to evaluate the ease of NGT installation using the conventional method and the SORT method. Methods We conducted a randomized clinical trial in a university hospital on 200 patients who required NGT insertion during Mar-Sep, 2019. The patients were randomly divided into two groups of 100 patients each, receiving the SORT and conventional methods. Finally, the feasibility of NGT insertion was examined in the two groups using the frequency of NGT insertion attempts, pain during insertion (based on the VAS score of 1 - 10), patient satisfaction with the procedure (rating of 1 - 10), and incidence of complications. Results There was no significant difference between the two groups in terms of age, body mass index, sex, and history of NGT use. However, the mean patient satisfaction score was higher (P < 0.05), whereas the mean pain score was lower (P < 0.05) in the group receiving the conventional method compared to the other group. Moreover, there was no statistically significant difference in complications (P > 0.05). Conclusions The study showed that using the conventional method in comparison with the SORT method was significantly better for NGT insertion in conscious patients in terms of patient satisfaction and pain relief. Therefore, it is recommended not to use the SORT method in conscious patients.
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Affiliation(s)
- Hamed Afsharjoo
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Anesthesiology Research Team, Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kavous Shahsavarinia
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzad Rahmani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Associate Professor, Emergency Medicine Department, Imam Reza (AS) Medical Research and Training Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Tel: +98-4133352078, Fax: +98-4133352078,
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de Oliveira AS, Ribeiro CJN, Oliveira ALC, Correia VODS, Pinto JS, Santos-Júnior E, Ribeiro MDCDO. Analgesic efficacy of 10% lidocaine spray during nasoenteral catheterization: Randomized triple-blind trial. Eur J Pain 2019; 24:536-543. [PMID: 31705581 DOI: 10.1002/ejp.1503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/25/2019] [Accepted: 11/03/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pain is a common experience during nasoenteral catheterization. Although the procedure causes discomfort and distress to patients, procedural pain remains neglected and undertreated. OBJECTIVE To evaluate the analgesic efficacy of the use of 10% lidocaine spray during nasoenteral catheterization. METHOD A randomized, triple-blind trial of 50 patients was performed. The patients were randomly assigned to two groups: an intervention group (IG), in which 10% lidocaine spray combined with 2% lidocaine gel was used, and a control group (CG), in which a saline solution spray combined with 2% lidocaine gel was used. Pain and discomfort were assessed during and after nasoenteral catheterization using numerical rating scale (NRS) and the visual analogue scale (VAS), respectively. RESULTS Intervention group participants reported lower pain scores during (0.20 ± 0.71 vs. 5.00 ± 2.84, p < .001; |d| = -0.677) and after (0.00 ± 0.00 vs. 2.80 ± 2.83, p < .001; |d| = -0.718) nasoenteral catheterization compared to the CG. CONCLUSION Spraying 10% lidocaine spray before nasoenteral catheterization was most effective for relieving discomfort and pain, with lower pain and discomfort recorded in NRS and VAS. Topical administration of 10% lidocaine spray is therefore a suggested measure for procedural pain relief related to nasoenteral catheterization. SIGNIFICANCE The use of 10% lidocaine spray was more effective in relieving procedural pain and discomfort during nasoenteral catheterization. Patients who received 10% lidocaine spray registered lower discomfort and pain scores than those from 2% lidocaine gel group; there were less complications among patients in the IG.
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Affiliation(s)
| | | | | | | | | | | | - Maria do Carmo de Oliveira Ribeiro
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil.,Department of Nursing, Federal University of Sergipe, Aracaju, Brazil
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Lor YC, Shih PC, Chen HH, Liu SJ, Chao HC, Hwang LC, Hsu YF, Yeh TL. The application of lidocaine to alleviate the discomfort of nasogastric tube insertion: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e9746. [PMID: 29384858 PMCID: PMC5805430 DOI: 10.1097/md.0000000000009746] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nasogastric (NG) tube insertion is a common procedure in the clinical setting that causes much discomfort and pain for the patient. Pain control is often suboptimal, as many NG tube insertions are performed without any pain-relieving supplements. The aim of this study was to summarize and critically evaluate the evidence from randomized controlled trials (RCTs) on the effect and adverse effects of lidocaine agents in reducing pain and discomfort associated with NG tube insertion. METHODS Databases from the Cochrane Library, MEDLINE, EMBASE, Airiti Library, PerioPath Index to Taiwan Periodical Literature, and Cumulative Index of Nursing and Allied Health (CINAHL) were searched from inception to April 2017. RCTs focusing on lidocaine before NG tube insertion were appraised. The primary outcome was the visual analog scale (VAS) score. The modified Jadad scale was used for quality assessment. Mean difference (MD) with 95% confidence intervals (95% CIs) and odds ratio (OR) for binary outcomes were assessed by a random effects model. Heterogeneity was determined by using the Cochran Q test and I statistics. Publication bias was analyzed by using a funnel plot analysis. RESULTS Ten RCTs enrolling 734 patients were included in the meta-analysis. Eight of the 10 RCTs reporting VAS scores had sufficient quantitative data to be pooled through meta-analysis. Results revealed a significant reduction in VAS score, with a MD of -26.05 and a CI of -28.21 to -23.89 with moderate heterogeneity (P < .001, I = 56%). There were no significant changes in difficulty of NG tube insertions (MD = -0.30, 95% CI, -1.30 to 0.70, P = .55), number of NG tube insertion attempts (MD = -0.22, 95% CI, -0.98 to 0.53, P = .56), nasal bleeding (OR = 0.62, 95% CI, 0.11-3.41, P = .59), and vomiting (OR = 0.30, 95% CI, 0.07-1.27, P = .10). CONCLUSION This meta-analysis suggests that applying lidocaine before NG tube insertion can alleviate pain and discomfort by 26% without increasing nasal bleeding or vomiting.
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Affiliation(s)
- You-Chen Lor
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City
| | - Pei-Ching Shih
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City
| | - Hsin-Hao Chen
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City
| | - Shu-Jung Liu
- Medical Library, Tamsui MacKay Memorial Hospital, New Taipei City
| | | | - Lee-Ching Hwang
- Department of Family Medicine, Taipei MacKay Memorial Hospital, Taipei City
- MacKay Medical College, New Taipei City
| | - Yen-Fen Hsu
- Department of Nursing, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Tzu-Lin Yeh
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City
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Does Topical Lidocaine Reduce the Pain Associated With the Insertion of Nasal Continuous Positive Airway Pressure Prongs in Preterm Infants?: A Randomized, Controlled Pilot Trial. Clin J Pain 2017; 32:948-954. [PMID: 26710224 DOI: 10.1097/ajp.0000000000000341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy of topical lidocaine 2% gel in reducing the pain associated with the insertion of nasal continuous positive airway pressure (nCPAP) prongs in preterm infants. MATERIALS AND METHODS A pilot randomized controlled trial. Sixty preterm infants, categorized into lidocaine (n=30) and control groups (n=30). The primary outcome was Premature Infant Pain Profile (PIPP) score, secondary outcomes included salivary cortisol, presence of cry, the duration of first cry, and adverse effects of lidocaine. RESULTS There were no statistically significant differences between lidocaine and control groups regarding PIPP scores (mean±SD: 7.2±2.3 vs. 9.3±3.0, respectively, P=0.086). None of the infants in the lidocaine group had severe pain defined as a PIPP score>12, compared with 3 (10%) infants in the control group (P=0.056). Salivary cortisol concentrations were not significantly different between the lidocaine and control groups (mean±SD: 2.57±1.79 vs. 4.82±1.61 μg/dL, respectively, P=0.11). Standardized effect sizes for topical lidocaine were medium to large for reduction in PIPP scores and large for reduction in salivary cortisol (Cohen d=-0.78 and -1.32, respectively). No adverse effects were reported in infants receiving lidocaine. DISCUSSION Our data suggest that topical lidocaine did not reduce the pain associated with the insertion of nCPAP prongs in preterm infants. However, the trends for lower PIPP scores in the lidocaine group and the effect sizes for lidocaine on PIPP scores and salivary cortisol were large enough so that a large-scale randomized clinical trial is warranted to confirm or refute our results. Such a study should compare 2 or more active pain interventions during nCPAP application, rather than evaluating a single intervention versus placebo or no treatment.
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Mohiuddin SA, Al Kaabi S, Butt T, Yakoob R, Khanna M. Down the wrong road – a case report of inadvertent nasogastric tube insertion leading to lung laceration and important pearls to avoid complications. Qatar Med J 2016; 2016:12. [PMID: 28534005 PMCID: PMC5427513 DOI: 10.5339/qmj.2016.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/31/2016] [Indexed: 11/15/2022] Open
Abstract
Nasogastric tube (NGT) insertion is a common procedure performed by residents and nursing staff to access the stomach. Although an apparently simple procedure, it is associated with technical difficulties and complications if proper care is not taken during insertion. We present a case of a 79-year-old female with multiple comorbidities who had a percutaneous enteral gastrostomy tube removed due to infection of an insertion site wound and a NGT was inserted for feeding. A few minutes post-insertion the patient developed shortness of breath and a drop in oxygen saturation. An immediate chest X-ray showed the NG tube traversing along the course of the trachea and the right main bronchus into the right upper abdomen with right-sided pneumothorax. The NG tube was immediately removed and a right chest drain inserted. Subsequent imaging showed right-sided pneumothorax with evidence of lung laceration and underlying lung collapse and diaphragmatic injury. The patient underwent a prolonged course of hospitalisation due to hospital-acquired pneumonia before being discharged upon clinical improvement. We highlight the fact that a simple and routine procedure such as NGT insertion can have devastating complications if due care is not taken. Along with a literature review, we provide and compare different methods to confirm correct placement of a NGT. The article also discusses important pearls for practising physicians and nursing staff to avoid such complications. Owing to the frequency of the procedure in hospitals and long-term care units, appropriate awareness among medical staff is necessary.
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Affiliation(s)
- Syed Adnan Mohiuddin
- Department of Gastroenterology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Saad Al Kaabi
- Department of Gastroenterology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Tarik Butt
- Department of Gastroenterology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rafie Yakoob
- Department of Gastroenterology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maneesh Khanna
- Department of Gastroenterology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Solomon R, Jurica K. Closing the Research-Practice Gap: Increasing Evidence-Based Practice for Nasogastric Tube Insertion Using Education and an Electronic Order Set. J Emerg Nurs 2016; 43:133-137. [PMID: 27773336 DOI: 10.1016/j.jen.2016.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 08/29/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
Patients and practitioners rate the insertion of a nasogastric tube as one of the most painful and distressing procedures performed. Research supports using lidocaine and a nasal vasoconstrictor to significantly decrease patient discomfort. The recommended medications were not being used routinely in a large urban emergency department. METHODS We identified departmental barriers using a nurse survey and physician interviews. We educated the nursing and physician staff about the comfort medications for nasogastric tube insertion recommended in the literature. In collaboration with the information technology department, we created an order set for the department's computerized physician order entry system linking the order for a nasogastric tube with the recommended comfort medications. RESULTS Six months after the educational campaign and availability of the new electronic order set, we compared the data from pre- and post-project chart reviews and found the use of literature-recommended comfort medications had increased from 23% to 93%. IMPLICATIONS FOR PRACTICE Nurses have a professional obligation to use the most current evidence-based practice available and to advocate for adequate pain management before, during, and after painful procedures. The use of evidence-based practice has been associated with an increase in both patient and staff satisfaction, improved clinical outcomes, and greater patient safety. An electronic order set combined with staff education resulted in a dramatic increase in the use of evidence-based practice for nasogastric tube insertion.
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Gaviola GC, Chen V, Chia SH. A prospective, randomized, double-blind study comparing the efficacy of topical anesthetics in nasal endoscopy. Laryngoscope 2013; 123:852-8. [PMID: 23404424 DOI: 10.1002/lary.23966] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/09/2012] [Accepted: 12/24/2012] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Transnasal endoscopy is commonly performed in an outpatient otolaryngology setting. Patients are typically administered a topical anesthetic and decongestant prior to this procedure to alleviate discomfort and improve visualization. There is no consensus on which topical anesthetic is most effective in optimizing patient experience during the procedure. OBJECTIVE To determine whether there is a difference in the efficacy between atomized 2% tetracaine and 4% lidocaine as a topical anesthetic prior to transnasal endoscopy. STUDY DESIGN Prospective, randomized, double-blind study. METHODS A total of 99 patients received oxymetazoline and were randomized to receive either 2% tetracaine or 4% lidocaine prior to transnasal endoscopy. Immediately following the procedure, participants completed a survey assessing level of discomfort and other adverse symptoms pertaining to the procedure using a 10-point visual analog scale (VAS). RESULTS There were no significant differences in VAS scores between the lidocaine and tetracaine groups. There were also no significant differences between genders in overall VAS scores and in the lidocaine and tetracaine subgroups. Older patients demonstrated significantly less discomfort or a sensation of bad taste overall. In contrast to patients receiving lidocaine, older patients receiving tetracaine experienced significantly less overall pain and discomfort, unpleasant taste, and dyspnea. CONCLUSION In patients undergoing transnasal endoscopy, use of either 2% tetracaine or 4% lidocaine has similar effect. Tetracaine may be a better choice in older patients, however.
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