Anesth Pain Med.  2016 Jan;11(1):42-48. 10.17085/apm.2016.11.1.42.

The effect of combining lidocaine with dexamethasone for attenuating postoperative sore throat, cough, and hoarseness

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea. unt1231@naver.com

Abstract

BACKGROUND
Despite the established efficacy of dexamethasone and lidocaine for preventing postoperative airway symptoms, no study has investigated the effects of dexamethasone plus lidocaine for attenuating postoperative airway symptoms. The purpose of this study was to explore whether combined dexamethasone and lidocaine are superior to dexamethasone alone in reducing postoperative sore throat, cough, and hoarseness for 24 h after tracheal extubation.
METHODS
In total, 70 female patients undergoing breast mass excision were randomized in a prospective, double-blinded manner into two groups: Group DL received intravenous dexamethasone (8 mg) plus lidocaine (1.5 mg/kg) 5 min before induction of anesthesia, and lidocaine was injected once more at the end of surgery. Group D received dexamethasone (8 mg) plus normal saline instead of lidocaine in the same manner as Group DL. We assessed the incidence and severity of postoperative sore throat, cough, and hoarseness 1 and 24 h after extubation.
RESULTS
The incidence of sore throat for 24 h after tracheal extubation was significantly lower in Group DL than in Group D (62.9% vs. 85.7%, respectively; P = 0.029). The severity of sore throat and hoarseness for 24 h after extubation was lower in Group DL than in Group D (P < 0.05). The incidence and severity of cough did not differ between the two groups for 24 h after extubation.
CONCLUSIONS
Lidocaine combined with dexamethasone is more effectively reduces the incidence and severity of sore throat and severity of hoarseness for 24 h after extubation in patients who have undergone breast mass excision surgery.

Keyword

Cough; Dexamethasone; Hoarseness; Lidocaine; Pharyngitis

MeSH Terms

Airway Extubation
Anesthesia
Breast
Cough*
Dexamethasone*
Female
Hoarseness*
Humans
Incidence
Lidocaine*
Pharyngitis*
Prospective Studies
Dexamethasone
Lidocaine

Figure

  • Fig. 1 Flow diagram of study enrollment and randomization.

  • Fig. 2 Incidence of postoperative sore throat, cough, and hoarseness at 1 and 24 h after extubation. Data shown represent numbers of patients. *P < 0.05 between Groups D and DL.


Reference

1. Kalil DM, Silvestro LS, Austin PN. Novel preoperative pharmacologic methods of preventing postoperative sore throat due to tracheal intubation. AANA J. 2014; 82:188–97. PMID: 25109156.
2. Park SY, Kim SH, Lee AR, Cho SH, Chae WS, Jin HC, et al. Prophylactic effect of dexamethasone in reducing postoperative sore throat. Korean J Anesthesiol. 2010; 58:15–9. DOI: 10.4097/kjae.2010.58.1.15. PMID: 20498806. PMCID: PMC2872887.
Article
3. Tanaka Y, Nakayama T, Nishimori M, Sato Y, Furuya H. Lidocaine for preventing postoperative sore throat. Cochrane Database Syst Rev. 2009; (3):CD004081. DOI: 10.1002/14651858.cd004081.pub2.
Article
4. D’Aragon F, Beaudet N, Gagnon V, Martin R, Sansoucy Y. The effects of lidocaine spray and intracuff alkalinized lidocaine on the occurrence of cough at extubation: a double-blind randomized controlled trial. Can J Anaesth. 2013; 60:370–6. DOI: 10.1007/s12630-013-9896-8. PMID: 23370978.
Article
5. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999; 89:652–8. DOI: 10.1213/00000539-199909000-00022. PMID: 10475299.
Article
6. Agarwal A, Gupta D, Yadav G, Goyal P, Singh PK, Singh U. An evaluation of the efficacy of licorice gargle for attenuating postoperative sore throat: a prospective, randomized, single-blind study. Anesth Analg. 2009; 109:77–81. DOI: 10.1213/ane.0b013e3181a6ad47. PMID: 19535697.
Article
7. Tazeh-Kand NF, Eslami B, Mohammadian K. Inhaled fluticasone propionate reduces postoperative sore throat, cough, and hoarseness. Anesth Analg. 2010; 111:895–8. DOI: 10.1213/ane.0b013e3181c8a5a2.
Article
8. Agarwal A, Nath SS, Goswami D, Gupta D, Dhiraaj S, Singh PK. An evaluation of the efficacy of aspirin and benzydamine hydrochloride gargle for attenuating postoperative sore throat: a prospective randomized, single-blind study. Anesth Analg. 2006; 103:1001–3. DOI: 10.1213/01.ane.0000231637.28427.00. PMID: 17000820.
Article
9. Borazan H, Kececioglu A, Okesli S, Otelcioglu S. Oral magnesium lozenge reduces postoperative sore throat: a randomized, prospective, placebo-controlled study. Anesthesiology. 2012; 117:512–8. DOI: 10.1097/ALN.0b013e3182639d5f. PMID: 22797283.
10. In JH, Kim YS, Joo JD, Jeon YS, Choi JW, Kim DW, et al. Does the stellate ganglion block decrease the postoperative sore throat? Anesth Pain Med. 2007; 2:42–5.
11. Thomas S, Beevi S. Dexamethasone reduces the severity of postoperative sore throat. Can J Anaesth. 2007; 54:897–901. DOI: 10.1007/BF03026793. PMID: 17975234.
Article
12. Takekawa K, Yoshimi S, Kinoshita Y. Effects of intravenous lidocaine prior to intubation on postoperative airway symptoms. J Anesth. 2006; 20:44–7. DOI: 10.1007/s00540-005-0363-8. PMID: 16421677.
Article
13. Park SH, Han SH, Do SH, Kim JW, Rhee KY, Kim JH. Prophylactic dexamethasone decreases the incidence of sore throat and hoarseness after tracheal extubation with a double lumen endobronchial tube. Anesth Analg. 2008; 107:1814–8. DOI: 10.1213/ane.0b013e318185d093. PMID: 19020122.
14. Soltani HA, Aghadavoudi O. The effect of different lidocaine application methods on postoperative cough and sore throat. J Clin Anesth. 2002; 14:15–8. DOI: 10.1016/S0952-8180(01)00344-0.
Article
15. Jaensson M, Gupta A, Nilsson UG. Gender differences in risk factors for airway symptoms following tracheal intubation. Acta Anaesthesiol Scand. 2012; 56:1306–13. DOI: 10.1111/j.1399-6576.2012.02771.x. PMID: 22998099.
Article
16. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984; 39:1105–11. DOI: 10.1111/j.1365-2044.1984.tb08932.x.
Article
17. Harding MB, McVey FK. Interview method affects incidence of postoperative sore throat. Anaesthesia. 1987; 42:1104–7. DOI: 10.1111/j.1365-2044.1987.tb05179.x.
Article
18. Sumathi PA, Shenoy T, Ambareesha M, Krishna HM. Controlled comparison between betamethasone gel and lidocaine jelly applied over tracheal tube to reduce postoperative sore throat, cough, and hoarseness of voice. Br J Anaesth. 2008; 100:215–8. DOI: 10.1093/bja/aem341. PMID: 18024955.
Article
19. Choi YH, Ji SM, Yoon SH, Park SI. Comparison of postoperative sore throat due to cuff inflation of the endotracheal tube using the pilot balloon palpation technique and the minimally occlusive volume technique during total laparoscopic hysterectomy. Anesth Pain Med. 2011; 6:380–4.
20. Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Br J Anaesth. 2002; 88:582–4. DOI: 10.1093/bja/88.4.582. PMID: 12066737.
Article
21. Sun L, Guo R, Sun L. Dexamethasone for preventing postoperative sore throat: a meta-analysis of randomized controlled trials. Ir J Med Sci. 2014; 183:593–600. DOI: 10.1007/s11845-013-1057-0. PMID: 24357270.
Article
22. Elhakim M, Ali NM, Rashed I, Riad MK, Refat M. Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy. Can J Anaesth. 2003; 50:392–7. DOI: 10.1007/BF03021038. PMID: 12670818.
Article
23. Cronstein BN, Kimmel SC, Levin RI, Martiniuk F, Weissmann G. A mechanism for the anti-inflammatory effects of corticosteroids: the glucocorticoids receptor regulates leukocyte adhesion to endothelial cells and expression of endothelial-leukocyte adhesion molecule 1 and intercellular adhesion molecule 1. Proc Natl Acad Sci U S A. 1992; 89:9991–5. DOI: 10.1073/pnas.89.21.9991. PMID: 1279685. PMCID: PMC50263.
24. Yukioka H, Yoshimoto N, Nishimura K, Fujimori M. Intravenous lidocaine as a suppressant of coughing during tracheal intubation in elderly patients. Anesth Analg. 1985; 64:1189–92. DOI: 10.1213/00000539-198512000-00010. PMID: 4061901.
Article
25. Solway J, Leff AR. Sensory neuropeptides and airway function. J Appl Physiol (1985). 1991; 71:2077–87.
Article
26. Yu MS, Kim JY, Kim HY. Intravenous dexamethasone pretreatment reduces remifentanil induced cough. Korean J Anesthesiol. 2011; 60:403–7. DOI: 10.4097/kjae.2011.60.6.403. PMID: 21738842. PMCID: PMC3121086.
Article
27. Figueredo E, Vivar-Diago M, Munoz-Blanco F. Laryngopharyngeal complaints after use of the laryngeal mask airway. Can J Anaesth. 1999; 46:220–5. DOI: 10.1007/BF03012599. PMID: 10210044.
Article
28. McCarthy GC, Megalla SA, Habib AS. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Drugs. 2010; 70:1149–63. DOI: 10.2165/10898560-000000000-00000. PMID: 20518581.
29. Backes JR, Bentley JC, Politi JR, Chambers BT. Dexamethasone reduces length of hospitalization and improves postoperative pain and nausea after total joint arthroplasty: a prospective, randomized controlled trial. J Arthroplasty. 2013; 28(8 Suppl):11–7. DOI: 10.1016/j.arth.2013.05.041. PMID: 23937923.
Full Text Links
  • APM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr