Document Detail


Comparison of topical anesthetics and vasoconstrictors vs lubricants prior to nasogastric intubation: a randomized, controlled trial.
MedLine Citation:
PMID:  10192668     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether pre-treatment of the nose and throat with topical anesthetics and vasoconstrictors would reduce the pain associated with nasogastric (NG) intubation. METHODS: This was a prospective, randomized, controlled trial assessing the pain of NG intubation in patients pretreated with topical anesthetics and vasoconstrictors vs surgical lubricants alone. The subjects were 40 alert, cooperative adult patients requiring NG intubation without allergies to the study medications or contraindications to their use from a suburban university-based ED. The patients in the experimental group had phenylephrine 0.5% sprayed in their noses followed by instillation of 5 mL of 2% lidocaine jelly. Their throats were sprayed with 2% tetracaine and 14% benzocaine. The control patients received intranasal lubrication only. The primary outcome measured was pain of NG intubation on a 100-mm visual analog scale. Other outcomes included nasal pain, discomfort from gagging, and the incidences of vomiting, choking, and epistaxis. RESULTS: The mean age (+/-SD) was 54.8+/-22.3 years; 20 (50%) were female. The patients who had a combination of topical anesthetics and vasoconstrictors inserted prior to NG intubation experienced significantly less overall pain/ discomfort than did the control patients [28.6 mm (95% CI = 17.3 to 39.9 mm) vs 57.5 mm (95% CI = 44.9 to 70.1 mm), p = 0.001]. The patients in the experimental group also experienced significantly less nasal pain than did the patients in the control group [18.1 mm (95% CI = 8.0 to 28.2 mm) vs 44.4 mm (95% CI = 30.4 to 58.6 mm), p = 0.003] and significantly less discomfort from gagging than the patients receiving pretreatment with a lubricant alone [24.1 mm (95% CI = 11.1 to 37.1 mm) vs 50.9 mm (95% CI = 36.7 to 65.1 mm), p = 0.006]. There was no between-group difference in the frequencies of adverse effects. CONCLUSIONS: Use of topical lidocaine and phenylephrine for the nose and tetracaine with benzocaine spray for the throat prior to NG intubation results in significantly less pain and discomfort than use of a nasal surgical lubricant alone. Widespread use of topical anesthetics and vasoconstrictors prior to NG intubation is recommended.
Authors:
A J Singer; N Konia
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  6     ISSN:  1069-6563     ISO Abbreviation:  Acad Emerg Med     Publication Date:  1999 Mar 
Date Detail:
Created Date:  1999-06-14     Completed Date:  1999-06-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  184-90     Citation Subset:  IM    
Affiliation:
Department of Emergency Medicine, State University of New York at Stony Brook, USA. asinger@epo.hsc.sunysb.edu
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MeSH Terms
Descriptor/Qualifier:
Administration, Topical
Anesthetics, Local / administration & dosage*
Female
Humans
Intubation, Gastrointestinal / adverse effects,  methods*
Lubrication*
Male
Middle Aged
Pain / etiology,  prevention & control*
Phenylephrine / therapeutic use
Prospective Studies
Vasoconstrictor Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Anesthetics, Local; 0/Vasoconstrictor Agents; 59-42-7/Phenylephrine
Comments/Corrections
Comment In:
Acad Emerg Med. 1999 Mar;6(3):166-9   [PMID:  10192665 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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