Effect of dexamethasone and lidocaine combination on incidence of post-operative sore throat: A meta-analysis and trial sequential analysis

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-07-11 DOI:10.1016/j.jclinane.2025.111924

Jibran Ikram , Aizaz Ali , Abdul Moeez , Muhammad Momin Khan , Ubaidullah , Aafeen Mujeeb , Muhammad Abdullah Ali , Sana Tanveer , Malik W.Z. Khan , Bushra Zaman , Aamer Syed , Muhammad Ahmad Nadeem , Ayesha Zahid , Mohammad Khudirat , Sawaira , Steven Minear , Sabry Ayad

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引用次数: 0

Abstract

Background

Postoperative sore throat (POST) is a common complication after endotracheal intubation, occurring in 30–50 % of patients. While lidocaine (local anesthetic) and dexamethasone (anti-inflammatory) are used individually to prevent POST, their combined efficacy remains unclear. This meta-analysis synthesizes evidence from randomized controlled trials to determine whether Intravenous dexamethasone-lidocaine combination is more effective than dexamethasone alone in reducing POST incidence.

Methods

A systematic search was conducted across PubMed, Embase, and Web of Science to identify studies comparing the effect of dexamethasone with and without lidocaine on the incidence of POST, cough, and hoarseness. Statistical analysis was performed on RevMan. Data were pooled using a random-effects model (Mantel-Haenszel method), with results reported as risk ratios (RR) and 95 % confidence intervals (CIs); heterogeneity was assessed using the I² statistic. A p-value less than 0.05 was considered statistically significant. We use Gradpro GDT and Trial sequential analysis to assess the certainty and reliability of evidence, respectively.

Results

Our search retrieved 116 articles, of which 31 were duplicates. At the end of the selection process based on prespecified eligibility criteria, three randomized controlled trials were included in the final meta-analysis. Dexamethasone-lidocaine significantly reduces the incidence of POST compared to dexamethasone alone, with a (RR: 0.53; 95 % CI: 0.37–0.75; P = 0.0003, I² = 0 %). The meta-analysis showed no statistically significant difference in postoperative cough (RR: 0.81; 95 % CI: 0.41–1.61; P = 0.55, I² = 24 %) and hoarseness (RR: 0.60; 95 % CI: 0.29–1.22; P = 0.16, I² = 24 %) between the dexamethasone-lidocaine combination and dexamethasone alone. Non-significance doesn't prove groups are comparable; wide confidence intervals suggest a potentially meaningful difference in cough incidence. GRADE assessment analysis showed high evidence for POST and cough but showed moderate evidence for hoarseness and cough. Trial sequential analysis showed insufficient evidence to conclude that Dexamethasone-lidocaine reduces the incidence of POST.

Conclusion

The dexamethasone-lidocaine combination suggests a clinically meaningful reduction in POST compared to dexamethasone alone, with consistent effects across studies. While not impacting hoarseness and cough, these robust findings support adopting this readily available, cost-effective strategy to enhance recovery after intubation. The combination's benefit on the most common postoperative complications justifies its inclusion in airway management protocols. Further trials are needed to support and enhance the reliability of this current evidence.

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地塞米松联合利多卡因对术后咽喉痛发生率的影响：荟萃分析和试验序贯分析

背景：术后喉咙痛（POST）是气管插管后常见的并发症，发生率为30 - 50%。虽然利多卡因（局麻药）和地塞米松（抗炎药）被单独用于预防POST，但它们的联合疗效尚不清楚。本荟萃分析综合了随机对照试验的证据，以确定静脉注射地塞米松-利多卡因联合使用是否比单独使用地塞米松更有效地降低POST发生率。方法系统检索PubMed、Embase和Web of Science，以确定比较地塞米松加与不加利多卡因对POST、咳嗽和声音嘶哑发生率影响的研究。在RevMan软件上进行统计分析。使用随机效应模型（Mantel-Haenszel方法）汇总数据，以风险比（RR）和95%置信区间（ci）报告结果；采用I2统计量评估异质性。p值小于0.05被认为具有统计学意义。我们分别使用Gradpro GDT和Trial序列分析来评估证据的确定性和可靠性。结果检索到116篇文献，其中重复31篇。在基于预先指定的资格标准的选择过程结束时，三个随机对照试验被纳入最终的荟萃分析。与单独使用地塞米松相比，地塞米松-利多卡因显著降低POST的发生率，(RR: 0.53；95% ci: 0.37-0.75；P = 0.0003, i2 = 0%)。meta分析显示两组术后咳嗽差异无统计学意义(RR: 0.81；95% ci: 0.41-1.61；P = 0.55, I2 = 24%)和声音嘶哑(RR: 0.60；95% ci: 0.29-1.22；P = 0.16, I2 = 24%)，地塞米松-利多卡因联用组与地塞米松单用组比较。不显著性不能证明群体具有可比性；较宽的置信区间提示咳嗽发生率有潜在意义的差异。GRADE评估分析显示POST和咳嗽有高证据，但声音嘶哑和咳嗽有中等证据。试验序列分析显示，没有足够的证据表明地塞米松-利多卡因可以降低POST的发生率。结论：与单用地塞米松相比，地塞米松-利多卡因联用可显著降低POST，且各研究的效果一致。虽然不影响声音嘶哑和咳嗽，但这些强有力的发现支持采用这种现成的、具有成本效益的策略来提高插管后的恢复。该组合对最常见的术后并发症的益处证明了其纳入气道管理方案的合理性。需要进一步的试验来支持和提高这一现有证据的可靠性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.