Nebulized Lidocaine Before Nasogastric Tube Insertion in Children Causes Distress

Nasogastric tubes often are inserted in children without analgesia or local anesthesia. In a randomized, double-blind, placebo-controlled trial, investigators in Australia assessed the efficacy of nebulized lidocaine for reducing pain and distress during this procedure in children aged 1 to 5 years. In adults, nebulized lidocaine has been shown to have less systemic absorption and a potentially better safety profile than topical lidocaine.

Thirty-eight children received 2% lidocaine (4 mg/kg) or saline administered via nebulizer for 5 minutes. The procedures were filmed, and each of six phases was scored independently by an emergency department attending physician and a nurse practitioner using the Face, Legs, Activity, Cry, and Consolability (FLACC) procedural pain scale (the primary outcome measure). A FLACC score of 10 indicates maximal distress; a difference of 2 points was considered clinically significant.

Eighteen patients in each group completed the study; more boys were in the lidocaine group, but otherwise the groups were similar at baseline. The range of FLACC scores varied widely during the different phases in both groups. Median scores in the lidocaine and placebo groups were highest during nebulization (6.3 and 6.0, respectively) and nasogastric tube insertion (9.8 and 9.5, respectively). Scores did not differ significantly between groups during any phase. Immediately after the procedure, ED nurses rated the overall pain of insertion on a visual analog scale as being lower in the lidocaine group. Adverse events included one endotracheal insertion in each group and one failed insertion in each group; none of these events resulted in harm.