Does the combination of intravenous lidocaine and dexamethasone reduce the incidence of postoperative sore throat? A randomized controlled trial

Background

The incidence of postoperative sore throat, cough, and hoarseness of voice remains significant, but the best method to reduce these symptoms is not yet definitive. The use of intravenous lidocaine combined with dexamethasone is a novel strategy to address these issues. This double-blind randomized controlled trial evaluated the incidence and severity of postoperative sore throat (POST) at rest and swallowing, cough, and hoarseness of voice by comparing the effects of a combination of intravenous lidocaine and dexamethasone versus intravenous dexamethasone alone.

Methods

One hundred forty patients, classified as American Society of Anesthesiologists physical status I or II, aged 18–60 years and scheduled for elective laparotomy requiring general anesthesia with endotracheal intubation for more than 120 min, were randomly assigned to receive either intravenous 8 mg dexamethasone (D group) or the same dose of dexamethasone combined with 1.5 mg/kg lidocaine (DL group). The incidence and severity of sore throat, cough, and hoarseness of voice were evaluated up to 24 h after surgery. The primary outcome measured was the incidence of POST at rest and swallowing.

Results

Data from 140 patients (70 patients in each group) was analyzed. The occurrence of a sore throat at rest was 41.4 % in group D and 21.4 % in group DL (P = .011). The incidence of postoperative sore throat (POST) when swallowing was 47.1 % for group D and 27.1 % for group DL (P = .014). Using dexamethasone combined with lidocaine reduced the severity of POST at rest and during swallowing at 1–2, 3, and 6 h after surgery. Multivariate logistic regression showed a reduction in POST incidence in the DL group (odds ratio, 0.4; 95 % confidence interval, 0.19–0.99; P = .05). There were no significant differences between the groups' incidence and severity of coughing or hoarseness.

Conclusions

Intravenous dexamethasone, combined with lidocaine, reduces the incidence and severity of postoperative sore throat at rest and during swallowing in patients requiring endotracheal intubation for over 120 min.