• G A Juhl and G P Conners.
• Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
• Emerg Med J. 2005 Apr 1; 22 (4): 243-5.

ObjectiveTo determine practice and attitudes of emergency physicians regarding procedural anaesthesia for nasogastric tube insertion (NGT).MethodsSurvey of resident/attending emergency physicians working in a tertiary care medical centre.ResultsOf 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.ConclusionsEmergency 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.

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