A randomized controlled trial: is water better than a standard lubricant in nasendoscopy?

OBJECTIVES

Previous studies have shown that nasendoscopy is made easier with the use of lubrication at the expense of the quality of the view obtained, but had no effect on the discomfort or pain experienced by the patient. We set out to determine whether the advantages of lubrication with a standard lubricant (KY Jelly) could be achieved by using water, without incurring the same disadvantages.

DESIGN

Single blind randomized controlled trial.

SETTING

Outpatient Departments at two District General Hospitals.

PARTICIPANTS

One hundred and fifty participants selected sequentially from patients requiring a nasendoscopy where the endoscope would be passed far enough to view the larynx. Patients requiring topical anaesthetic were excluded.

METHODS

Patients were randomly assigned to have either water or standard lubricant applied to the nasendosope prior to nasendoscopy. Levels of pain experienced by the patient were recorded on a visual analogue score as well as visual analogue scores from the clinician for the levels of difficulty in passing the endoscope. All participants who were entered the study completed the study. Endoscopy was performed by all grades of medical staff.

MAIN OUTCOME MEASURES

Levels of pain experienced by the participants were assessed by a visual analogue scale. Difficulty of passing the scope was indicated by the endoscopist using a visual analogue scale, as was the quality of image obtained.

RESULTS

Endoscopists found the insertion of the endoscope was easier and the image better when water was used rather than KY Jelly. There was no significant difference in reported in levels of pain experienced by the patient.

CONCLUSION

Although the use of water as a lubricant during nasendoscopy confers no additional benefit in term of the levels of pain suffered by patients during the procedure, it makes the insertion of the endoscope easier and provides a better quality image than standard lubrication.