Comparing the effect of ketamine and benzydamine gargling with placebo on post-operative sore throat: A randomized controlled trial


Department of Anaesthesiology, Iran University of Medical Sciences, Tehran, Iran


Background: Air way intubation for general anesthesia usually leads to sore throat after surgery. Ketamine plays an important role to block a number of receptors related to pain. Benzydamine hydrochloride is a non-steroidal anti-inflammatory drug that has been used to improve oropharyngeal disorders. In this study, it was intended to compare the effect of gargling different solutions before the surgery on post-operative sore throat (POST) in patients who underwent general anesthesia for hysterectomy.
Materials and Methods: A total of 60 patients who underwent the elective hysterectomy were entered to the randomized controlled trial regarding to the eligibility criteria. Patients were simply randomly allocated to three groups and received one code. Every code was representative for a specific drug: 20 cc normal saline (control group) or 1.5 mg benzydamine in 20 cc solution or 20 mg ketamine in 20 cc solutions. All the research teams were blinded to the received solutions. POST was evaluated with numerical rating scale. The data were entered to SPSS software and analysis of variance (ANOVA) and Kruskal-Wallis one-way analysis of variance test, were performed.
Results: The mean ages of ketamine, benzydamine, and normal saline recipients were not significantly different. The trend of the severity of sore throat during the first 24 h after the operation in ketamine recipients was significantly lower than the other two groups (P < 0.001).
Conclusion: The pain scale after surgery was reduced by using both ketamine and benzydamine, but the ketamine effect was more noticeable.


McHardy FE, Chung F. Postoperative sore throat: Cause, prevention and treatment. Anaesthesia 1999;54:444-53.  Back to cited text no. 1
Stout DM, Bishop MJ, Dwersteg JF, Cullen BF. Correlation of endotracheal tube size with sore throat and hoarseness following general anesthesia. Anesthesiology 1987;67:419-21.  Back to cited text no. 2
Richards C. Major tracheal disruption after emergency uncomplicated endotracheal intubation. Emerg Med J 2010;27:543.  Back to cited text no. 3
Scuderi PE. Postoperative sore throat: More answers than questions. Anesth Analg 2010;111:831-2.  Back to cited text no. 4
Jaensson M, Gupta A, Nilsson UG. Gender differences in risk factors for airway symptoms following tracheal intubation. Acta Anaesthesiol Scand 2012;56:1306-13.  Back to cited text no. 5
Al-Qahtani AS, Messahel FM. Quality improvement in anesthetic practice: Incidence of sore throat after using small tracheal tube. Middle East J Anesthesiol 2005;18:179-83.  Back to cited text no. 6
Ogata J, Minami K, Horishita T, Shiraishi M, Okamoto T, Terada T, et al. Gargling with sodium azulene sulfonate reduces the postoperative sore throat after intubation of the trachea. Anesth Analg 2005;101:290-3.  Back to cited text no. 7
Tazeh-Kand NF, Eslami B, Mohammadian K. Inhaled fluticasone propionate reduces postoperative sore throat, cough, and hoarseness. Anesth Analg 2010;111:895-8.  Back to cited text no. 8
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;28:11-6.  Back to cited text no. 9
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.  Back to cited text no. 10
Rudra A, Ray S, Chatterjee S, Ahmed A, Ghosh S. Gargling with ketamine attenuates the postoperative sore throat. Indian J Anaesth 2009;53:40-3.  Back to cited text no. 11
[PUBMED]  Medknow Journal  
Sandroni P, Davis MD. Combination gel of 1% amitriptyline and 0.5% ketamine to treat refractory erythromelalgia pain: A new treatment option? Arch Dermatol 2006;142:283-6.  Back to cited text no. 12
Gammaitoni A, Gallagher RM, Welz-Bosna M. Topical ketamine gel: Possible role in treating neuropathic pain. Pain Med 2000;1:97-100.  Back to cited text no. 13
Mahon WA, De Gregorio M. Benzydamine: A critical review of clinical data. Int J Tissue React 1985;7:229-35.  Back to cited text no. 14
Angelini Products and Medicines. [Accessed 2010 Feb 22].  Back to cited text no. 15
Pagé MG, Katz J, Stinson J, Isaac L, Martin-Pichora AL, Campbell F. Validation of the numerical rating scale for pain intensity and unpleasantness in pediatric acute postoperative pain: Sensitivity to change over time. J Pain 2012;13:359-69.  Back to cited text no. 16
Zhong B. How to calculate sample size in randomized controlled trial? J Thorac Dis 2009;1:51-4.  Back to cited text no. 17
Ruangsin S, Wanasuwannakul T, Pattaravit N, Asim W. Effectiveness of a preoperative single dose intravenous dexamethasone in reducing the prevalence of postoperative sore throat after endotracheal intubation. J Med Assoc Thai 2012;95:657-60.  Back to cited text no. 18
Biro P, Seifert B, Pasch T. Complaints of sore throat after tracheal intubation: A prospective evaluation. Eur J Anaesthesiol 2005;22:307-11.  Back to cited text no. 19
Loeser EA, Orr DL 2 nd , Bennett GM, Stanley TH. Endotracheal tube cuff design and postoperative sore throat. Anesthesiology 1976;45:684-7.  Back to cited text no. 20
Canbay O, Celebi N, Sahin A, Celiker V, Ozgen S, Aypar U. Ketamine gargle for attenuating postoperative sore throat. Br J Anaesth 2008;100:490-3.  Back to cited text no. 21
Park SY, Kim SH, Noh JI, Lee SM, Kim MG, Kim SH, et al. The effect of intravenous low dose ketamine for reducing postoperative sore throat. Korean J Anesthesiol 2010;59:22-6.  Back to cited text no. 22
Chan L, Lee ML, Lo YL. Postoperative sore throat and ketamine gargle. Br J Anaesth 2010;105:97.  Back to cited text no. 23
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.  Back to cited text no. 24
Gulhas N, Canpolat H, Cicek M, Yologlu S, Togal T, Durmus M, et al. Dexpanthenol pastille and benzydamine hydrochloride spray for the prevention of post-operative sore throat. Acta Anaesthesiol Scand 2007;51:239-43.  Back to cited text no. 25