Pediatric nasogastric tube insertion: topical sprays don’t ease distress

  • Craig SS & al.
  • Lancet Child Adolesc Health
  • 15 Apr 2019

  • International Clinical Digest
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Takeaway

  • In children undergoing nasogastric tube insertion, pretreatment with topical lidocaine and phenylephrine sprays is no better than placebo in easing visible distress.
  • Commentary cautions against conclusion that analgesics fail to relieve pain in children "until we are confident that the outcome measures we are using adequately measure analgesic efficacy.”

Why this matters

  • Though nasogastric tube insertion is painful and distressing, inadequate analgesia is the norm. 

Study design

  • Single-center prospective, randomized, controlled, double-blind, superiority trial (n=107).
  • Convenience sample of children ages 6 months to 5 years about to undergo nasogastric tube placement in tertiary emergency department were randomly assigned to preinsertion lidocaine and phenylephrine nasal spray vs placebo.
  • Outcome: procedure-related distress via Face, Legs, Activity, Cry, Consolability (FLACC) scale (0-10).
  • Funding: Monash Health Senior Medical Staff Association; Australasian College for Emergency Medicine. 

Key results

  • Median FLACC score, study drugs vs placebo: 
    • 9 (interquartile range [IQR], 7-10) vs 9 (IQR, 8-10).
    • Median between-group difference: −1 (95% CI, −2.7 to 0.7); P=.21.

Limitations

  • Less ill patients may have been preferentially enrolled, resulting in spectrum bias.
  • FLACC cannot distinguish distress related to pain vs other unpleasant aspects.
  • No gold-standard instrument exists for assessing pediatric procedure-related pain and distress, say the authors.