Comparison of the efficacy between lidocaine spray plus lidocaine jelly lubrication and lidocaine jelly lubrication alone prior to nasogastric intubation: a prospective double-blind randomized controlled study.

OBJECTIVE: Although a common procedure, nasogastric (NG) intubation is also painful and unsatisfactory. Previous studies showed the benefits of local anesthesia in various forms over lubricant jelly alone, but they are rarely used due to their inconvenience and unavailability. The authors conducted a double-blind randomized controlled study to compare a commercial-available 10% lidocaine spray plus 2% lidocaine jelly lubrication and 2% lidocaine jelly lubrication alone prior to NG intubation.

MATERIAL AND METHOD: Patients who fulfilled the indications for NG intubation were randomized to receive either 10% lidocaine spray or placebo (normal saline) spray to the nostril and throat prior to NG intubation. NG tubes lubricated with 2% lidocaine jelly were then inserted by experienced physicians. Physician, who sprayed, inserted the NG tubes and collected the patient's data, did not know the content of the spray, while patients were also blinded against the information of the spray.

RESULTS: Sixty patients were included in the present study. Thirty one randomly received lidocaine spray and 29 received placebo spray. There were more female patients in the lidocaine group (65% vs. 28%, p=0.04), but ages, indications for NG intubation, size of NG tube, and physicians' experience in the procedure were similar in both groups. Patients' discomfort after being sprayed was also similar in both groups. However during the NG intubation, the patients in the lidocaine group experienced less pain as measured by visual analog scale (23.6 +/- 16.6 vs. 43.1 +/- 31.4 mm, p=0.005) and less discomfort (30.0 +/- 24.4 vs. 51.4 +/- 30.0 mm, p=0.004) than the placebo group. Ninety-three percent of the patients in the lidocaine group favored the same spray for their next intubations, while 65% of the placebo group did (p = 0.009). In addition, there was more physicians' satisfaction in the lidocaine group as measured by 5-point Likert scale (p=0.041). Likewise, 61% of the physicians favored lidocaine spray compared to 34.5% of the placebo spray (p=0.038). Degree of difficulty, duration of intubation, number of attempts and success rates of NG intubations were as well similar in both groups. No complications were found in the present study.

CONCLUSION: 10% lidocaine spray plus 2% lidocaine jelly lubrication was more effective in relieving patients' pain, discomfort, and resulted in higher physicians' satisfaction. There were also no additional side effects as compared to 2% lidocaine jelly lubrication alone. Therefore, it should be recommended for routine application.