The management of the airway is a fundamental responsibility for anaesthetists when caring for patients undertaking diagnostic procedures or surgical operations [1]. Unfortunately, endotracheal intubation is a high-risk procedure, with significant rates of complications [2], POST is defined as pain or irritation in the laryngeal or pharyngeal region that develops during the postoperative hours. In contrast, the sore throat is a general, non-medical term often used to describe pharyngitis and may encompass a range of symptoms, including cough, laryngitis, dysphagia, tracheitis, or hoarseness [3]. The reported frequency of POST differs among various studies, with most reporting a prevalence ranging from 14.5% to 50% [4]. POST typically peaks within six postoperative hours and gradually decreases in both incidence and severity over time [5]. POST is primarily attributed to injuries of the supraglottic structures, often resulting from laryngoscope insertion, as well as injuries to the subglottic structures, which may be triggered by endotracheal intubation or endotracheal tube cuff pressure [6]. Several factors have been associated with the etiology of POST, including dehydration and/or edema of the mucosa, tracheal ischemia resulting from endotracheal tube cuff pressure, vigorous oropharyngeal suctioning, mucosal erosion due to contact between fragile airway tissues and the endotracheal tube, as well as postoperative vomiting [7,8]. Non-pharmacological methods to decrease the incidence of POST and its severity include pre-intubation gargling with agents such as licorice or sodium azulene sulfonate, use of normal saline to inflate the cuff of the endotracheal tube, administering cold vapor after extubation, and gargling by using honey-lemon water. Another approach involves using thermal-softened endotracheal tubes to reduce mechanical    and     thermal      injuries     associated   with traditional cold and rigid tubes. Although several pharmacological strategies have been suggested, none has gained universal acceptance [9]. Various pharmacological agents are used in the preoperative setting, intraoperative setting, and postoperative setting to minimize the occurrence of POST after general anaesthesia. These agents include corticosteroids (such as dexamethasone, betamethasone, fluticasone, and methylprednisolone), α₂-agonists, local anaesthetics, opioids, nonsteroidal anti-inflammatory drugs, and ketamine [10]. Dexamethasone is a potent glucocorticoid drug used for a variety of indications [11]. Steroids are well known for their anti-inflammatory properties, which include the inhibition of leukocyte migration and suppression of cytokine release at sites of inflammation. Additionally, they inhibit fibroblast proliferation, thereby limiting tissue injury. Dexamethasone, in particular, produces its anti-inflammatory effects by blocking arachidonic acid metabolism, resulting in reduced production of leukotriene and suppression of interleukin-2 activity [12]. Lidocaine possesses antihyperalgesic, analgesic, and anti-inflammatory properties, making it an adjunct to be used with general anesthesia [13]. Lidocaine may offer several potential benefits in the perioperative setting, including its anti-inflammatory effects, prevention of hyperalgesia, reduction of propofol-induced injection pain, enhancement of the depth of general anesthesia, protection against bronchial reactivity through broncho-tracheal relaxation during surgery, and attenuation of nociceptive and cardiovascular responses to surgical stress [14,15].

Aim of the study: To compare intravenous dexamethasone and lidocaine for the effectiveness in the prevention of POST.

A double-blind, randomized controlled, comparative study was conducted in the Private Nursing Home Hospital during the period from January to June 2025. A convenient sample of 300 pregnant women who were planned to undergo elective cesarean section under general anaesthesia and met the inclusion criteria was enrolled in the current study. Those patients were categorized into the dexamethasone group which included 150 patients who received intravenous dexamethasone (8 mg) ampule and the lidocaine group which consisted of 150 patients who received intravenous lidocaine (1.5 mg/kg) ampule. The inclusion criteria included patients with grade 1 or grade 2a according to the Modified Cormack-Lehane classification and grade II American Society of Anesthesiologists. Patients with chronic steroid use, patients with a history of sore throat and hoarseness before surgery, patients with more than two endotracheal intubation attempts, and patients with complicated intubation were excluded from the study. At the time of induction, the agent was prepared by an individual not participating in the anaesthetic-surgical procedure. The researcher was unaware of the injected agent. The gathered data were body mass index (BMI), age, duration of intubation, time of attempts, duration of anaesthesia, and need for external pressure. 

Statistical Analysis

Statistical Package for the Social Sciences, version 26 software, was used for analysis. The categorical variables were displayed as numbers and percentages, while continuous variables were displayed as mean ± standard deviation. The calculation of the differences between study groups were achieved by the t-test and the Chi-square test. A p-value less than 0.05 reflected statistical significance.

The study registered 300 patients. The difference was not significant between dexamethasone and lidocaine groups regarding age, with a P-value of 0.234 and BMI, with a P-value of 0.074, as displayed in Table 1.

Table 1: Basic characteristics of the patients

The characteristics of anaesthesia, including duration of intubation, duration of anaesthesia, number of attempts, and applications of external pressure, were not significantly different between the study groups (P-values were 0.772, 0.245, 0.218, and 0.659) as displayed in Table 2.

Table 2: Characteristics of the anaesthesia

A statistically significantly higher POST incidence was in the lidocaine group at 21.3% compared to the dexamethasone group at 12.7% (P-value=0.046), as displayed in Table 3 and Figure 1.

Table 3: Distribution of POST incidence in the two study groups

Figure 1: Incidence of POST

Regarding the severity of POST, no statistically significant variance was obtained between the study groups with a P-value of 0.170 as displayed in Table 4.

Table 4:   The association between the severity of POST and the drug used in the current study

For better patient satisfaction, avoiding POST is one of the main priorities among patients undergoing endotracheal intubation. Many drugs were used to reduce POST with varying degrees of success [16]. This study was one of several that aimed to evaluate the success of certain drugs in preventing POST and assessing their impact. The main outcome of the current study was that the POST incidence was significantly decreased by using dexamethasone compared to using lidocaine. In comparison, the same results were obtained in another study that was done in Ethiopia by Samue et al. [17] which revealed that the POST incidence was 40% with lidocaine use and 32%. This agreed with the results of another study that was done in Egypt by Mohammed et al. [18] which concluded that intravenous administration of dexamethasone seems to be more promising than lidocaine in decreasing the POST incidence. In the same line, Asish et al. [19] concluded that dexamethasone, alone or combined with lidocaine, effectively reduced the incidence of POST in patients undergoing prolonged tracheal intubation, with incidences of 36% in the dexamethasone group versis 43% in the lidocaine group. The second finding of the present study, both dexamethasone and lidocaine had the same outcome on the severity of POST. This agreed with the results of another study that was in Ethiopia by Samue et al. [17] The same results were obtained in another study that was done in Egypt by Mostafa et al. [20]. In the same line, Hassan et al. [21] revealed that a prophylactic one dose of intravenous dexamethasone (8 mg) decreases both the incidence and severity of POST.

Dexamethasone use seemed to be more effective than lidocaine use in reducing the incidence of POST. It is recommended to use dexamethasone regularly to help lower the occurrence of POST.

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