Prophylactic Effects of Lidocaine or Beclomethasone Spray on Post-Operative sore Throat and Cough after Orotracheal Intubation

Document Type: Original


Department of Anesthesiology, Babol University of Medical Sciences, Babol, Iran.


Post-operative sore throat and cough are common complications of endotracheal intubation. These conditions may be very distressing for the patient and may lead to unpleasant memories. This study was performed in order to determine whether beclomethasone and lidocaine spray could reduce the frequency of post-operative sore throat and hoarseness after tracheal extubation.
 Materials and Methods:
Ninety women (18–60 years of age) with an American Society of Anesthesiologists (ASA) physical status I or II and undergoing elective mastoidectomy were randomized into three groups of 30 patients. The endotracheal tubes in each group were sprayed with 50% beclomethasone, 10% lidocaine hydrochloride, or normal saline (control group) before endotracheal intubation. Patients were examined for sore throat (none, mild, moderate, or severe), cough, and hoarseness at 1 and 24 h after extubation.
There was a significantly lower incidence and severity of post-operative sore throat in the beclomethasone group than the lidocaine and control groups (P<0.05) at each observation time point. At 24 h after extubation, the incidence and severity of sore throat and cough was significantly lower in the lidocaine compared with the control group. The incidence of hoarseness was not significantly different among the three groups.
Spraying beclomethasone and lidocaine on the endotracheal tube is a simple and effective method to reduce the incidence and severity of post-operative sore throat.


Main Subjects

1. 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(4):1001–3.

2.  Jaensson M, Gupta A, Nilsson UG. Risk factors for development of postoperative sore throat and hoarseness after endotracheal intubation in women: a secondary analysis. AANA J 2012; 80(4 Suppl):        S67–73.

3. Tabari M, Soltani G, Zirak N, Alipour M, Khazaeni K. Comparison of Effectiveness of Betamethasone gel Applied to the Tracheal Tube and IV Dexamethasone on Postoperative Sore Throat: A Randomized Controlled Trial. Iran J Otorhinolaryngol 2013; 25(73):215–20.

4.  Hung NK, Wu CT, Chan SM, Lu CH, Huang YS, Yeh CC, et al. Effect on postoperative sore throat of spraying the endotracheal tube cuff with benzydamine hydrochloride, 10% lidocaine, and 2% lidocaine. Anesth Analg 2010; 111(4):882–6.

5. Jaensson M, Olowsson LL, Nilsson U. Endotracheal tube size and sore throat following surgery: a randomized-controlled study. Acta Anaesthesiol Scand. 2010; 54(2):147–53.

6.  Rudra A, Ray S, Chatterjee S, Ahmed A, Ghosh S. Gargling with ketamine attenuates the postoperative sore throat. Indian J Anaesth 2009; 53(1):40–3.

7.  Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg 2004; 99(4):1253–7.

8.  Yukioka H, Yoshimoto N, Nishimura K, Fujimori M. Intravenous lidocaine as a suppressant of coughing during tracheal intubation. Anesth Analg 1985; 64(12): 1189–92.

9.  Navarro LH, Braz JR, Nakamura G, Lima RM, Silva Fde P, MódoloNS. Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial. Sao Paulo Med J 2007; 125(6):322–8.

10. 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(6):1814–8.

11. Tazeh-Kand NF, Eslami B, Mohammadian K. Inhaled fluticasone propionate reduces postoperative sore throat, cough, and hoarseness. Anesth Analg 2010; 111(4):895–8.

12.  Huang YS, Hung NK, Lee MS, Kuo CP, Yu JC, Huang GS et al. The effectiveness of benzydamine hydrochloride spraying on the endotracheal tube cuff or oral mucosa for postoperative sore throat. Anesth Analg 2010; 111(4):882–6.

13.  Kazemi A, Amini A. The effect of betamethasone gel in reducing sore throat, cough, and hoarseness after laryngo-tracheal intubation. Middle East J Anesthesiol 2007; 19(1):197–204.

14.  Shaaban AR, Kamal SM. Comparison between betamethasone gel applied over endotracheal tube and ketamine gargle for attenuating postoperative sore throat, cough and hoarseness of voice. Middle East J Anesthesiol 2012; 21(4):513–9.

15.  Honarmand A, Safavi M. Beclomethasone inhaler versus intravenous lidocaine in the prevention of postoperative airway and throat complaints: a randomized, controlled trial. Ann Saudi Med 2008; 28(1):11–6.

16. El Hakim M. Beclomethasone prevents postoperative sore throat. Acta Anaesthesiol Scand 1993; 37(3):250–2.

17. 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(2):215–8.

18. Thomas S, Beevi S. Dexamethasone reduces the severity of postoperative sore throat. Can J Anaesth 2007; 54(11):897–901.

19. Stride PC. Postoperative sore throat: topical hydrocortisone.Anaesthesia 1990;45(11):968–71.

20. Yregard L, Cassuto J, Tarnow P, Nilsson U. Influence of local anaesthetics on inflammatory activity post burn. Burns 2003; 29(4):335–41.

21. Caracas HC, Maciel JV, Martins PM, de Souza MM, Maia LC. The use of lidocaine as an anti-
inflammatory substance: a systematic review. J Dent 2009; 37(2):93–7.

22. Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology 2000; 93(3):858–75.

23.Takekawa K, Yoshimi S, Kinoshita Y. Effects of intravenous lidocaine prior to intubation on postoperative airway symptoms. J Anesth 2006; 20(1):44–7.

24. Maruyama K, Sakai H, Miyazawa H, Iijima K, Toda N, Kawahara S, et al. Laryngotracheal application of lidocaine spray increases the incidence of postoperative sore throat after total intravenous anesthesia. J Anesth 2004; 18:237–40.

25. Honma K, Kamachi M, Akamatsu Y, Yoshioka M, Yamashita N. Lidocaine spray 10 min prior to intubation: effects on postoperative sore throat. J Anesth 2010; 24(6):962–5.