Lidocaine use in NGT insertion

 Q: Which of the following facilitates the nasogastric tube (NGT) insertion? (select one)

A) topical lidocaine 

B) nebulized lidocaine

Answer: B

It may be surprising that concomitant use of nebulized lidocaine helps more than the topical use of lidocaine during NGT insertion. This is due to the fact that nebulized lidocaine suppresses the cough reflex during NGT insertion. 

In addition, to suppress the gag reflex it may help to ask the patient, if co-operative and alert, to sip water during the procedure. Sipping liquid not only helps to advance the tube with swallowing but also relieves NGT's irritation at the back of the oropharynx to some degree.

Topical lidocaine so far failed to show any benefit in the insertion of NGT in two studies 20 years apart (1) (2).

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References:

1. West HH. Topical anesthesia for nasogastric tube placement. Ann Emerg Med. 1982 Nov;11(11):645. 

2.  Uri O, Yosefov L, Haim A, Behrbalk E, Halpern P. Lidocaine gel as an anesthetic protocol for nasogastric tube insertion in the ED. Am J Emerg Med. 2011 May;29(4):386-90. 

3. Cullen L, Taylor D, Taylor S, Chu K. Nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized, double-blind trial. Ann Emerg Med. 2004 Aug;44(2):131-7.