- 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.
- 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.
- 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.
- 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.