Emergency physicians’ practices and attitudes regarding procedural anaesthesia for nasogastric tube insertion

• Published in: Emergency medicine journal : EMJ 2005-04, Vol.22 (4), p.243-245
• Main Authors: Juhl, G A, Conners, G P
• Format: Article
• Language: English
• Subjects: Administration, Topical; Analgesics; Anesthesia; Anesthesia - methods; Anesthetics - administration & dosage; Attitude of Health Personnel; Clinical Competence; Emergencies; Emergency medical care; Emergency Medicine - standards; Gels; Humans; Intubation, Gastrointestinal - adverse effects; Intubation, Gastrointestinal - psychology; Intubation, Gastrointestinal - standards; Lidocaine - administration & dosage; Lubricants & lubrication; nasogastric intubation; nasogastric tube; pain; Pain - prevention & control; Pain management; Patients; Physicians; procedural anaesthesia; Short Report; Studies
• ISSN: 1472-0205; 1472-0213
• DOI: 10.1136/emj.2004.015602

Objective: To determine practice and attitudes of emergency physicians regarding procedural anaesthesia for nasogastric tube insertion (NGT). Methods: Survey of resident/attending emergency physicians working in a tertiary care medical centre. Results: Of 68 physicians, 46 responded: 98% believed that awake and alert patients find NGT insertion uncomfortable/painful; 93% used measures to reduce this, most commonly lubricant gel, topical anaesthetic spray, lidocaine gel, and distraction/use of a child life worker; 28% believed these provided adequate pain control and 37% believed they were inadequate. Topical anaesthetic spray, lidocaine gel, and nebulised/atomised anaesthetics were believed the most practical to administer and 44% actually used these. Nebulised/atomised anaesthetics, systemic anxiolytics, and topical anaesthetic spray were believed the most effective at pain control but only 24% actually used these. While 39% of respondents were satisfied with their current practice, 46% were dissatisfied: 91% would change their practice if new literature were to show a convenient way to effectively reduce this pain. Conclusions: Emergency physicians do not actually use the measures they believe are most practical/most effective at reducing the pain associated with NGT insertion. Thus, there may be a barrier to the use of these measures. Improvement in procedural anaesthesia for NGT insertion in emergency departments is needed and desired by emergency physicians.