Betamethasone gel compared with lidocaine jelly to reduce tracheal tube related postoperative airway symptoms: a randomized controlled trial

Abstract

Background and objectives: Post-operative airway symptoms can be troublesome to patients following an uneventful general anesthesia with endotracheal intubation. In this study, we compared the effectiveness of lubricating an endotracheal tube with betamethasone gel or lidocaine jelly with using an unlubricated tube in reducing the incidence and severity of postoperative sore throat, hoarseness and cough.Methods: This was a prospective, randomized, single-blind comparative study carried out among 120 ASA I and II patients aged 18-65 years undergoing elective surgery under general anesthesia with endotracheal intubation. Patients were randomly divided into three groups of 40 patients each. Endotracheal tube used for patients in group C was unlubricated, while that for group B and group L were lubricated up to 15 cm mark with 2.5 ml of 0.05% betamethasone gel or 2% lidocaine jelly respectively. Incidence and severity of postoperative sore throat, hoarseness and cough were observed at 1, 6 and 24 h following extubation. Results:At 24 h following extubation, group B had the lowest incidence of postoperative sore throat among the three groups (group B: 12.5% vs group L: 37.5% vs group C: 25%; p = 0.036). Severity of postoperative sore throat at 24 h was less with betamethasone (score 0: 87.5%, 1: 10%) compared with lidocaine (score 0: 62.5%, 1: 37.5%) and control (score 0:75%, 1: 20%) (p = 0.006). Observations at other times and of other variables were comparable. Conclusion:Wide spread application of 0.05% betamethasone gel to lubricate the endotracheal tube significantly reduces the incidence and severity of sore throat at 24 h of extubation but not of hoarseness or cough.

Topical application of corticosteroids to tracheal tubes to prevent postoperative sore throat in adults undergoing tracheal intubation: a systematic review and meta‐analysis

“…S1). After applying our inclusion and exclusion criteria, we finally included 20 randomised controlled trials involving 2200 patients (Table ). The ASA physical status classification, corticosteroid agents and comparators are listed in Table .…”

“…Corticosteroids were applied from the distal tip of tracheal tubes to a distance of 15 cm (eight trials) , 10 cm (one trial) , 17 cm (one trial) and to one‐third of the distal area over the tubes (two trials) ; the remainder did not specify the size of the lubricated area. All but five of the trials were published in English; four were written in Chinese and one in Indonesian .…”

“…All but five of the trials were published in English; four were written in Chinese and one in Indonesian . We attempted to contact 14 authors, and three responded .…”

“…Data on postoperative sore throat 24 h after surgery were provided in 18 trials (1506 patients) . Corticosteroids applied to tracheal tubes were associated with a reduced incidence of postoperative sore throat compared with non‐analgesic comparators, RR (95%CI) 0.39 (0.32–0.46), I 2 = 33.5% (Fig.…”

“…We conducted trial sequential analysis, using the O'Brien–Fleming method of alpha‐spending function to assess the robustness of the outcomes against type‐1 and type‐2 error . A relative risk reduction of 25% for postoperative sore throat was considered clinically meaningful based on the most conservative value from power calculations presented in included trials . We maintained a 5% risk of type‐1 error and a power of 80%, and required that information size was calculated based on a relative risk reduction of 25% for postoperative sore throat.…”