• Chelsea Taylor Manning, Jacob Dillon Buinewicz, Thomas Patrick Sewatsky, Evangelia Zgonis, Kathy Gutierrez, Michael F O'Keefe, and Kalev Freeman.
• Department of Surgery, University of Vermont College of Medicine, Burlington, VT.
• Acad Emerg Med. 2016 Jul 1; 23 (7): 766-71.

ObjectivesPatients 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).MethodsWe 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.ResultsWe 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.ConclusionsPremedication with 2 mg of IV midazolam reduces pain of NGT insertion in ED patients without the need for full procedural sedation.© 2016 by the Society for Academic Emergency Medicine.

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