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Introduction
Nasogastric (NG) intubation is one of the most common procedures performed in the emergency department (ED) as well as in other hospital settings; it is also among the most painful and uncomfortable procedures performed in this setting. 1-4 Several methods have been proposed to reduce the pain of NG intubation, such as using lubricant gel, topical lidocaine sprays, lidocaine gel as well as other non-medical strategies. 5 Despite all these methods, insertion of the NG tube following the administration of water-soluble lubricating gel is still the method used in some medical centres. 5 6
Previous studies have documented the safety and efficacy of inhaled lidocaine delivered by atomisation, nebulisation and intermittent positive pressure breathing for facilitating this painful procedure; however, lidocaine is not commonly used with any of these methods in practice because of their limitations. 7 8 However, 2% lidocaine gel has been considered as the best option for providing topical anaesthesia during NG tube insertion. 9
Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has potent peripheral analgesic and antihyperalgesic effects. 10 Similar to other NMDA antagonists, its analgesic properties differ from local anaesthetics as it prevents the central perception of pain. 11 Several studies have reported the analgesic effects of topical ketamine. 12-18 Ketamine is readily available in the ED, so we hypothesised that intranasal ketamine may be an effective medication in reducing pain during NG tube insertion. To our knowledge, ketamine has never been used for this purpose, so this study was designed to compare the level of pain during NG tube insertion in subjects receiving local ketamine plus water-soluble lubricating gel with those undergoing the routine method performed in our centre (water-soluble lubricating gel alone).
Material and methods
Study design
After being approved by the ethical board committee of Tehran University of Medical Sciences, this prospective double-blind randomised clinical trial was performed in the ED of a teaching hospital during 6 consecutive months between January and June 2008. The hospital in which this research was conducted is a 1000-bed facility and is the largest teaching hospital in the country. It is completely equipped with all facilities found in a trauma centre including a helicopter pad, so the hospital is capable of accepting patients transferred via helicopter emergency service from different parts...