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

Faiz, Seyed Hamid Reza; Rahimzadeh, Poupak; Poornajafian, Alireza; Nikzad, Naghme

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

Authors

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

Abstract

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.

Keywords

References

1.	McHardy FE, Chung F. Postoperative sore throat: Cause, prevention and treatment. Anaesthesia 1999;54:444-53.
2.	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.
3.	Richards C. Major tracheal disruption after emergency uncomplicated endotracheal intubation. Emerg Med J 2010;27:543.
4.	Scuderi PE. Postoperative sore throat: More answers than questions. Anesth Analg 2010;111:831-2.
5.	Jaensson M, Gupta A, Nilsson UG. Gender differences in risk factors for airway symptoms following tracheal intubation. Acta Anaesthesiol Scand 2012;56:1306-13.
6.	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.
7.	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.
8.	Tazeh-Kand NF, Eslami B, Mohammadian K. Inhaled fluticasone propionate reduces postoperative sore throat, cough, and hoarseness. Anesth Analg 2010;111:895-8.
9.	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.
10.	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.
11.	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. [PUBMED]
12.	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.
13.	Gammaitoni A, Gallagher RM, Welz-Bosna M. Topical ketamine gel: Possible role in treating neuropathic pain. Pain Med 2000;1:97-100.
14.	Mahon WA, De Gregorio M. Benzydamine: A critical review of clinical data. Int J Tissue React 1985;7:229-35.
15.	Angelini Products and Medicines. http://www.angelinipharma.com. [Accessed 2010 Feb 22].
16.	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.
17.	Zhong B. How to calculate sample size in randomized controlled trial? J Thorac Dis 2009;1:51-4.
18.	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.
19.	Biro P, Seifert B, Pasch T. Complaints of sore throat after tracheal intubation: A prospective evaluation. Eur J Anaesthesiol 2005;22:307-11.
20.	Loeser EA, Orr DL 2 ^nd , Bennett GM, Stanley TH. Endotracheal tube cuff design and postoperative sore throat. Anesthesiology 1976;45:684-7.
21.	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.
22.	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.
23.	Chan L, Lee ML, Lo YL. Postoperative sore throat and ketamine gargle. Br J Anaesth 2010;105:97.
24.	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.
25.	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.

Advanced Biomedical Research