Intranasal lidocaine spray during nasogastric tube placement: a randomized, double-blind, placebo-controlled trial

Nasogastric tube (NGT) insertion is a common emergency department procedure frequently associated with pain and poor patient tolerance. This study evaluated whether intranasal 10% lidocaine spray reduces procedural pain and facilitates NGT insertion in adult patients. In this prospective, randomized, double-blind, placebo-controlled trial, 120 adult patients requiring NGT insertion were randomized to receive either intranasal 10% lidocaine spray (n = 63) or placebo spray (n = 57). Two puffs were administered into each nostril one minute before the procedure. The co-primary outcomes were procedural pain assessed using a Numerical Rating Scale (NRS) and first-pass insertion success, defined as successful tube placement during the initial continuous insertion without withdrawal for repositioning or reinsertion. Secondary outcomes included procedure duration, patient satisfaction, willingness to undergo the procedure again if necessary, and adverse events. Continuous outcomes were compared using non-parametric tests, categorical outcomes using Pearson’s chi-square or Fisher’s exact test, and between-group differences were estimated using the Hodges–Lehmann method with 95% confidence intervals. Patients in the lidocaine group reported significantly lower procedural pain scores than those in the placebo group (median NRS, 3 [IQR 2–3] vs. 5 [IQR 4–6]; Hodges–Lehmann difference, 2 [95% CI 2–3]; p < 0.001). First-pass insertion success was higher in the lidocaine group (98.4% vs. 28.1%; absolute difference, 70.3% [95% CI 58.3–72.4]; p < 0.001). Procedure duration was also shorter with lidocaine (median, 87 [IQR 82–97] vs. 118 [IQR 92–157] seconds; Hodges–Lehmann difference, 31 s [95% CI 19–45]; p < 0.001). Patient satisfaction did not differ significantly between groups. No serious adverse events were observed. Intranasal 10% lidocaine spray may improve patient comfort and procedural outcomes during NGT insertion in adult emergency department patients. Given the single-center design and potential limitations related to procedural blinding, larger multicenter studies are needed to confirm these findings. ClinicalTrials.gov, NCT07103915. Registered on 5 August 2025. Retrospectively registered.