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, MSc, FNLA, FAHA
Last Reviewed:  January 2021