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Does topical local anaesthesia reduce the pain and distress of nasogastric tube insertion in children?
  1. Daniel Owen Mort1,
  2. Ilana Levene2
  1. 1 Accident + Emergency, Royal Berkshire Hospital, Reading, UK
  2. 2 Paediatrics, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Dr Daniel Owen Mort, Accident + Emergency, Royal Berkshire Hospital, Reading RG1 5AN, UK; dan.mort52{at}gmail.com

https://doi.org/10.1136/archdischild-2020-319197

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    Scenario

    A 2-year-old girl presents with 3 days of vomiting and diarrhoea. On examination, she is clinically dehydrated, but haemodynamically stable. Unfortunately, she fails an oral fluid challenge in the department, so she is admitted and rehydrated enterally via a nasogastric tube (NGT). The new medical student attached to the department, upset by watching a screaming child being pinned down, asks you if anything could have been done to make the procedure less distressing for the patient—she recently listened to an American podcast that recommended nebulised local anaesthetic. You realise you have become somewhat desensitised to procedural distress, feel a little guilty and wonder what evidence exists for using topical anaesthetic agents to reduce the distress associated with NGT insertion (NGTI) in children.

    Structured clinical question

    In a child requiring NGTI (population), does topical local anaesthesia (intervention), compared with placebo (control), reduce the pain and distress associated with insertion (outcome)?

    Search

    MEDLINE, PubMed, EMBASE, CINAHL, EMCARE, AMED, HMIC and PsychINFO were searched with the following string:

    (((nebulis*).ti,ab OR (nebuliz*).ti OR (topical*).ti,ab OR (aerosol*).ti,ab OR (spray*).ti,ab OR (gel*).ti,ab OR (atomi*).ti,ab OR (intranas*).ti,ab OR (jelly).ti,ab OR (applied).ti OR (applic*).ti) AND ((anesth*).ti,ab OR (anaesth*).ti,ab OR (analges*).ti OR (lidocain*).ti,ab OR (lignocain*).ti,ab OR (benzocain*).ti,ab OR (ketamin*).ti,ab OR exp “ANESTHESIA, LOCAL”/ OR exp “ANESTHETICS, LOCAL”/ OR exp “ANALGESIA”/ OR exp “PAIN”/)) AND (exp “INTUBATION, GASTROINTESTINAL”/ OR (nasogastri*).ti,ab OR (“nasogastric tube”).ti OR (NG tube).ti,ab OR (NG).ti). Only English-language articles were examined.

    The last search was performed on 28 October 2019. This search retrieved 361 articles, of which two were included in this systematic review (figure 1). These two studies included a total of 136 children aged between 6 months and 5 years.

    Figure 1

    Paper selection process.

    Commentary

    NGTI has been rated as one of the most distressing procedures performed in the paediatric emergency setting.1 One study2 showed that, although 98% of surveyed emergency doctors …

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    Footnotes

    • Contributors DOM designed the systematic search terms, performed the search and subsequent paper selection, wrote the manuscript draft, and designed the figure and tables. IL identified the topic for systematic review, supervised the search strategy and paper selection, and revised the manuscript, figure and tables.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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