Randomised, single blinded, controlled, prospective study comparing ketamine, lignocaine and chlorhexidine gargle in prevention of post-operative sore throat

Abstract

Background: Postoperative sore throat is a common complaint in patients after extubation and can be distressing to the patients. Hence we aimed to compare efficacy of lignocaine, ketamine and chlorhexidine gargle for the control of postoperative sore throat. Materials and Methods: After institutional ethical committee clearance, 100 patients were allotted into 4 groups of 25 each in this randomized, double blind, control study. The study solution for gargle in Group L, Group C and Group K contained 50mg lignocaine, 30mg chlorhexidine and 50 mg ketamine in 30ml sterile water respectively while in Group W it was 30ml of sterile water. The study solution was given 5 minutes before induction and the patients were made to gargle it for 30 seconds. The post-operative sore throat (POST) grading was done at 0, 2, 6 and 24 hours after extubation. Results: At 0 hour, there was a significant lower grades of POST in Group K as compared to Group W (p=0.011). At the 4 hour interval, the grades of POST were significantly lower in group K (p=0.001) and Group L (p<0.001) whencompared to Group C.At the 24 hour time interval, the grades of POST were lower in Group L (p=0.007) and Group K (p<0.001) when compared to Group C. At the same time interval, significantly lower grades of POST in Group W was seen compared to Group C (p=0.001). At the end of all time intervals there was no statistical significant difference in the severity of POST in Group L and Group K. There were no significant haemodynamic changes in any of the groups. Conclusion: Ketamine and Lignocaine gargles are effective in the reduction of postoperative sore throat without any changes in haemodynamics.

Topical application of ketamine to prevent postoperative sore throat in adults: A systematic review and meta‐analysis

“…Our initial database search and additional search produced 2478 and 44 titles and abstracts, respectively. After application of our inclusion and exclusion criteria (Table ), we included in our analysis 41 randomized controlled trials involving 3784 participants (Figure ).…”

“…Ketamine was topically administered as a single dose prior to surgery in all studies. Ketamine was administered as nebulization and gargle in 13 and 26 trials, respectively, and in the other one, the endotracheal tube was lubricated with ketamine . The dose of ketamine was fixed in 36 studies (50 mg, 23 studies; 40 mg, 10 studies; 25 mg, three studies; 20 mg, one study).…”

“…Ketamine was topically administered as a single dose prior to surgery in all studies. Ketamine was administered as nebulization and gargle in 13 40,49,56,58,60,61,63,65,67,68,70,72,74 and 26 trials, [36][37][38][39][41][42][43][44][45][46][47][48][50][51][52][53]55,57,59,62,64,66,69,71,73,75,76 respectively, and in the other one, the endotracheal tube was lubricated with ketamine. 54 The dose of ketamine was fixed in 36 studies (50 mg, 23 studies 37,39,44,[48][49][50][51][52][53]…”

“…A total of 14 studies examined both non-analgesic and active comparators. [42][43][44]46,53,57,60,63,65,68,69,73,75,76 In all, 22 studies were reported from India, six from Iran, 43,46,[54][55][56]76 three each from China 40,44,71 and Egypt, 42,57,68 two each from Indonesia 47,59 and Nepal, 39,77 and one each from Malaysia, 38 South Korea, 51 and Turkey. 36 All but six studies were reported in English: three in Chinese, 40,44,71 two in Indonesian, 47,59 and one in Persian.…”

“…76 In total, 27 studies used a four-level classification system to rate the presence and severity of postoperative sore th roat [36][37][38][39][40][41][44][45][46][47][48]54,56,59,60,[62][63][64][65][66][67][68][69][70]72,74,75 and 10 reported its incidence. 42,49,50,52,55,57,58,61,71,73 Six studies and two used a visual analogue scale 44,51,55,57,71,76 and numerical rating scale, 43,53 respectively, to rate severity. We sent e-mails to 36 study authors for further information and 10 responded.…”