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Nebulized Lidocaine to Reduce Pain with Nasogastric Tube (NGT) Placement

Summary:

  • Place 4 mL of 4% - 10% lidocaine solution into nebulizer and administer until the 4 mL are gone; then immediately place NG tube.
    • Note: Using 4 mL of 10% lidocaine provides the patients with 400 mg of lidocaine. Many institutions do not have access to these higher concentrations that were studied, therefore using 3 - 4 mL of 2% lidocaine (preservative free) can be used though it may be less effective. 

Clinical Rationale: 

  • Pain associated with NGT placement can be reduced by up to 57%.
  • Using this intervention however is associated with more epistaxis (nosebleeds) probably due to providers being more aggressive during placement since the pain is decreased. 
  • Current evidence is most supported in adults; one study in children failed to show a benefit.
  • The use of nebulized lidocaine is not associated with methemoglobinemia as seen with the excessive use of Hurricaine (20% benzocaine) spray on mucosal membranes.


Editor-in-Chief:
  Anthony J. Busti, MD, PharmD, FNLA, FAHA
Last Reviewed:  August 2015

Original Studies

  • Cullen L et al. Nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized, double-blind trial. Ann Emerg Med 2004;44(2):131-7. PubMed

Supporting Studies

  • Kuo YW et al. Reducing the pain of nasogastric tube intubation with nebulized and atomized lidocaine: a systematic review and meta-analysis. J Pain Symptom Manage 2010;40:613-620. PubMed

MESH Terms or Keywords

  • Nebulized Lidocaine, Nasogastric Tube (NGT) Placement