Treatment of postoperative sore throat after endotracheal intubation in third molar surgery

Introduction Postoperative sore throat (POST) is a frequent complaint following endotracheal intubation with incidence rates varying from 14.4% to 61%.1-3 It ranks along nausea as the most common complaint after endotracheal intubation for general anaesthesia.4 Regardless of the incidence or duration, POST is rated as a patient’s 8th most undesirable outcome in the postoperative period,5 and is certainly an opportunity to improve patient outcomes.6 In order to improve patient satisfaction, avoiding POST is a major priority in patients undergoing endotracheal intubation.5 Drugs such as clonidine, betamethasone gel, benzydamine hydrochloride and chamomile extract spray have been used to reduce POST with varying degrees of success.7-10 Simple, safe, and inexpensive therapies to reduce or eliminate POST would be helpful and could improve patient satisfaction significantly. Honey has been used as a medication throughout the ages and in more recent times has been ‘rediscovered’ by the medical profession for its medicinal properties. It has antimicrobial, antioxidant, anaesthetic and wound healing properties. Although the actual mechanism responsible for the healing power of honey is not well understood, it has proven to be effective in healing nearly all types of wounds including abrasions, ulcerations, burns and septic wounds.11 Honey and lemon juice in tea are thought to coat the pharyngeal mucosa thus soothing inflammation and reducing irritation.12 Strepsils® (Amyl-m-cresol) have also been successfully used to treat oral inflammation and pain and more recently to reduce the incidence of POST when administered preoperatively.13 However, the efficacy of these two medications in the treatment of POST postoperatively is unknown, especially in patients undergoing third molar surgery. Therefore, the aim of this study was to evaluate the efficacy of honey and lemon juice with tea and Strepsils® versus no medication in relieving postoperative sore throat. Abstract Objectives: The aim of this study was to evaluate the efficacy of honey and lemon juice in tea versus Strepsils® versus no pain remedy in relieving postoperative sore throat (POST). Methods and materials: Sixty American Society of Anesthesiologists (ASA) physical status I, non-smoking patients scheduled to undergo removal of third molars under general anesthesia were enrolled after obtaining signed informed consent. Participants were randomly divided into three groups to receive no medication, honey and lemon in tea, or Strepsils® lozenges at the following intervals: at 30 minutes after surgery; before going to sleep on the first night; and the following morning. The incidence and severity of POST were evaluated using a four-point scale at three different intervals i.e. prior to administering medication and 30 minutes and 24 hours after surgery. Results: POST scores for the groups given honey and lemon in tea (P < 0.01) and Strepsils® (P < 0.001) were significantly lower after administration of the first dose. The severity of POST significantly decreased for 24 hours after surgery for all three groups (P < 0.05). Overall, Strepsils® were the most effective in relieving POST. Discussion: POST was reduced significantly with the administration of honey and lemon in tea and Strepsils® immediately after surgery. Likewise, a 24-hour follow-up of patients confirmed the effectiveness of honey and lemon in tea and Strepsils® lozenges in relieving POST. Conclusions: Postoperative use of honey and lemon in tea and Strepsils® lozenges reduces sore throat after third molar surgery, especially if administered within 30 minutes postoperatively. Clinical significance: Early postoperative administration of honey and lemon in tea or Strepsils® lozenges reduces postoperative sore throat after endotracheal intubation for third molar surgery.