ABSTRACT
SUMMARY:
Topical Mucosal Anesthetics prior to nasopharyngeal procedures
Contents Bibliography:
Page:
Title:
Wolfe, T. R., D. E. Fosnocht, et al.
(2000). “Atomized lidocaine as topical anesthesia for nasogastric tube
placement: A randomized, double-blind, placebo-controlled trial.” Ann Emerg
Med 35(5): 421-5.
STUDY OBJECTIVE: To evaluate the efficacy of topical atomized 4% lidocaine in reducing the pain associated with nasogastric tube (NGT) placement. METHODS: This prospective, randomized, double-blind, placebo-controlled trial was conducted in the emergency department of a university teaching hospital. Study participants were alert, hemodynamically stable adult patients requiring NGT placement for diagnostic or therapeutic purposes. Atomized 4% lidocaine or normal saline solution was administered in the nasopharynx and oropharynx before NGT placement. All patients also received topical 2% lidocaine jelly intranasally after atomization. The pain of NGT placement was measured using a standard 100-mm visual analog scale. RESULTS: A total of 40 patients were enrolled in the study, with 20 in the lidocaine group and 20 in the placebo group. Mean pain scores were 37.4 mm (95% confidence interval [CI] 25.4 to 49.4) for atomized lidocaine and 64.5 mm (95% CI 51.8 to 77.1) for placebo with a mean difference of 27.1 mm (95% CI 14.8 to 39.4), achieving both clinical and statistical significance. CONCLUSION: Atomized nasopharyngeal and oropharyngeal 4% lidocaine results in clinically and statistically significant reductions in pain during NGT placement.
Singer, A. J. and N. Konia (1999).
“Comparison of topical anesthetics and vasoconstrictors vs lubricants prior to
nasogastric intubation: a randomized, controlled trial.” Acad Emerg Med
6(3): 184-90.
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.
Nott, M. R. and J. H. Hughes (1995).
“Topical anaesthesia for the insertion of nasogastric tubes.” Eur J
Anaesthesiol 12(3): 287-90.
The effect of topical anaesthesia on the discomfort caused by insertion of nasogastric tubes in conscious patients was assessed. An intra-nasal spray of 4% lignocaine significantly reduced the distress experienced without any increase in difficulty (P 0.01).
Gaumann, D. M., E. Tassonyi, et al.
(1992). “Effects of topical laryngeal lidocaine on sympathetic response to rigid
panendoscopy under general anesthesia.” ORL J Otorhinolaryngol Relat Spec
54(1): 49-53.
The sympathetic response to rigid bronchoscopy, laryngoscopy and esophagoscopy, performed under general anesthesia with isoflurane, was examined in patients who either received 5 ml of 2% lidocaine (n = 7) or 5 ml of saline (n = 7), sprayed on larynx and upper trachea under direct laryngoscopy, 2 min before the introduction of the rigid bronchoscope. Blood pressure, heart rate and plasma catecholamine and lidocaine levels were measured at specific time points of the study. Topical lidocaine led to a rapid and prolonged increase in plasma lidocaine levels. Patients treated with lidocaine showed a small but significant decrease in plasma epinephrine levels from baseline following endotracheal intubation and extubation, as compared to the saline control group. Blood pressure and heart rate response during rigid panendoscopy, isoflurane requirements and time interval from termination of panendoscopy to extubation were not different between the two groups. However, in contrast to the control group, patients who had received lidocaine had no significant rise in blood pressure and heart rate from baseline following the introduction of the rigid bronchoscope. The benefit of this moderate hemodynamic stabilizing effect of lidocaine has to be weighted against the risk of decreased protective airway reflexes due to topical laryngeal lidocaine during recovery from anesthesia.
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