Does Routine Midazolam Administration Prior to Nasogastric Tube Insertion in the Emergency Department Decrease Patients’ Pain? (A Pilot Study)

• Published in: Academic emergency medicine Vol. 23; no. 7; pp. 766 - 771
• Main Authors: Manning, Chelsea Taylor, Buinewicz, Jacob Dillon, Sewatsky, Thomas Patrick, Zgonis, Evangelia, Gutierrez, Kathy, O'Keefe, Michael F., Freeman, Kalev, Bird, Steven B.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2016
• Subjects: Adult; Anesthesia; Clinical outcomes; Clinical trials; Double-Blind Method; Drug Combinations; Emergency medical care; Emergency Service, Hospital; Female; Humans; Hypnotics and Sedatives - administration & dosage; Intubation; Intubation, Gastrointestinal; Lidocaine; Male; Midazolam - administration & dosage; Middle Aged; Pain - drug therapy; Pain management; Pain Management - methods; Pain Measurement; Phenylephrine; Pilot Projects; Placebo effect; Premedication
• ISSN: 1069-6563; 1553-2712; 1553-2712
• DOI: 10.1111/acem.12961

Objectives Patients report pain and discomfort with nasogastric tube (NGT) intubation. We tested the hypothesis that premedication with midazolam alleviates pain during NGT placement in the emergency department (ED) by > 13 on a 100‐mm visual analog scale (VAS). Methods We performed a double‐blind randomized controlled pilot study, assigning ED patients requiring NGT placement to midazolam or placebo. All patients received intranasal cophenylcaine; additionally, they received an intravenous (IV) dose of the study drug, either 2 mg of IV midazolam or saline control. Nurses placed NGTs while observed by research staff, who then interviewed subjects to determine the primary outcome of pain using a VAS. Additional data collected from patients and their nurses included discomfort during the procedure, difficulty of tube insertion, and complications. Results We enrolled 23 eligible patients and obtained complete data in all: 10 midazolam and 13 controls. We found a significant reduction in mean pain VAS score of −31 (95% confidence interval = −53 to −9 mm) with 2 mg of midazolam (mean ± SD = 52 ± 30 mm), compared to placebo (mean ± SD = 21 ± 18 mm), more than double the effect size considered clinically relevant. Treatment did not impact ease of placement and there were no serious adverse effects. Conclusions Premedication with 2 mg of IV midazolam reduces pain of NGT insertion in ED patients without the need for full procedural sedation.