Lidocaine for pain and discomfort relief during nasogastric tube insertion: A systematic review

Background Nasogastric tube (NGT) insertion is a common procedure in hospitalized adults, associated with pain and discomfort. Lidocaine has been studied to reduce procedural pain, but evidence on the most effective, clinically feasible approach remains limited. Objective This review aimed to systematically review and synthesise evidence on the effectiveness and safety of topical anaesthetics or lubricants for reducing pain and discomfort during NGT insertion in adults. Method A systematic search was conducted in MEDLINE, Cochrane Database of Systematic Reviews, CENTRAL, and CINAHL from inception to October 28, 2025. Randomized controlled trials (RCTs) in adults were eligible if they assessed non-nebulised topical anaesthetics or lubricants and reported pain, discomfort, procedure-related outcomes, or complications. Screening, data extraction, and quality assessment using the 13-item JBI Critical Appraisal Checklist for RCTs were performed independently by two reviewers. Findings were synthesised descriptively using a best-evidence approach. Results Of 390 unique records, five RCTs were included. Studies investigated lidocaine in various formulations and administration routes, including spray, drops, gel, and atomised lidocaine, compared with placebo. Despite heterogeneity in study characteristics, all studies reported reductions in pain or discomfort scores with lidocaine. Best-evidence synthesis showed strong evidence for pain reduction and moderate evidence for reductions in discomfort and cough. Evidence for other procedure-related outcomes was insufficient. Conclusion Topical lidocaine during NGT insertion in adults appears to reduce pain and is well tolerated. However, heterogeneity and limited data preclude strong recommendations. Further high-quality trials are warranted to identify optimal formulation, dosage, and administration route for routine practice. Registration The review was registered in the international prospective register of systematic reviews ( http://www.crd.york.ac.uk/PROSPERO/ ), registration number: CRD420251177888.