Anesthesiology

A nasal spray containing lidocaine and phenylephrine appears to be no better than placebo in relieving procedure-related distress in infants and young children undergoing nasogastric-tube insertion; Australian researchers have found. “Having a nasogastric tube placed is really uncomfortable. There have been many studies in adults which suggest that we can make it hurt less by using a numbing medication, either with a spray, or gel; or as an inhaled mist;” Dr. Simon Craig of Monash Medical Centre, in Melbourne, told Reuters Health by email.

Nasogastric-tube insertion

“It is almost impossible in a young child to work out whether they are upset during a procedure because it hurts, or because it is scary; or because it’s yucky having something place in your nose and down your throat,” he explain. “In young children, usual practice in most places is just to hold them still while the procedure is done; without much pain relief. .

Unfortunately; the procedure is quite distressing; and we were hoping to demonstrate that the use of medication in children might help;” Dr. Craig added. He and his colleagues conducted a double-blind; randomized; placebo-controlled superiority trial in 100 children ages 6 months to 5 years who are assign to receive either a commercially available nasal spray with 5% lidocaine hydrochloride and 0.5% phenylephrine hydrochloride or placebo (0.9% sodium chloride).

Available nasal spray

The study; online April 15 in The Lancet Child and Adolescent Health; is the first adequately power trial to evaluate the effectiveness of topical local anesthetic and vasoconstrictor use before nasogastric tube insertion in children in that age range, the researchers say.

It was based on a convenience sample of patients who are slated to have a nasogastric tube insert as part of treatment in the emergency department of a tertiary referral center from 2014 to 2017. The most common reason for tube insertion is dehydration arising from gastroenteritis.

Pain relief in children

One spray of active medication delivered 5 mg lidocaine and 0.5 mg phenylephrine. Children weighing 6-12 kg received one spray to each nostril; and children over 12 kg received two sprays to each nostril. Because The primary outcome is procedure-relate distress as measure with the Face, Legs, Activity, Cry and Consolability (FLACC) scale.
There was no between the treatment and placebo groups in the median FLACC score between active treatment (9) and placebo (9) during insertion. Noting the difficulties of distinguishing between pain and distress in young children; she concludes that “we must be cautious; as the authors are; not to fall into the trap of saying that analgesics do not provide pain relief in children until we are confident that the outcome measures we are using adequately measure analgesic efficacy.”