Effects of intravenous diclofenac on postoperative sore throat in patients undergoing laparoscopic surgery at Aga Khan University Hospital, Nairobi: A prospective, randomized, double blind controlled trial

Background: postoperative sore throat is the commonest complication after endotracheal intubation. The efficacy of intravenous non-steroidal anti-inflammatory drugs in alleviating postoperative sore throat has not been investigated. Objective: To evaluate the effect of intravenous diclofenac sodium on the occurrence and severity of postoperative sore throat. Methods: 42 in-patients scheduled for laparoscopic surgery were randomized into two equal groups to receive either a single dose of 75mg intravenous diclofenac sodium in addition to standard treatment taken at our hospital for the prevention of postoperative sore throat or to receive standard treatment only. All patients were interviewed postoperatively at 2, 6 and 18 hours. Data of the baseline characteristics, the incidence and severity of sore throat were collected. If sore throat was present, a Visual Analogue Score was used to assess its severity. Results: the baseline characteristics of the participants were similar. The majority of the patients undergoing laparoscopic surgery were women. There was no statistically significant difference in the occurrence or severity of postoperative sore throat between the diclofenac and standard treatment groups at 2, 6 and 18 hours postoperatively. Conclusion: Intravenous diclofenac sodium does not reduce the occurrence or severity of postoperative sore throat. African Health Sciences 2013; 13(4): 999 1006 http://dx.doi.org/10.4314/ahs.v13i4.20 *Corresponding author: Dr Vitalis Mung’ayi Department of Anaesthesia Aga Khan University East Africa Phone: +254 20 366 2157 Email: vitalis.mung’[email protected] Introduction Sore throat is a common, uncomfortable, distressing sequel of tracheal intubation that contributes to postoperative morbidity and patient dissatisfaction . The incidence of postoperative sore throat (POST) after tracheal intubation varies from 6.6 to 90%. The pathogenesis of POST is attributed to traumatisation, local irritation and inflammation of the airway mucosa during tracheal intubation. Numerous non-pharmacological and pharmacological measures aimed at attenuating POST have been investigated with varying success. Among the non-pharmacological methods, a smaller sized endotracheal tube (ETT), lubricating the ETT with water soluble jelly, careful airway instrumentation, intubation after full relaxation, gentle oropharyngeal suctioning, minimizing intracuff pressure, and extubation when the tracheal tube cuff is fully deflated have been reported to decrease the incidence of POST 13, 16, . Various pharmacological measures, including lignocaine, steroids, non-steroidal anti-inflammatory drugs, gargling with azulene sulfonate, have been reported to decrease the incidence of POST 1, 2, 9, 18, 19, 39, . Despite the inflammatory pathogenesis of POST, the evidence supporting the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for POST is limited 8, . Topical diclofenac epolamine, a NSAID, has been shown to be effective in reducing the severity and incidence of POST. However, the more readily available diclofenac sodium which has been found to be effective in the treatment of postoperative pain when used orally, rectally or intravenously has not been evaluated for its effect on POST. This study aimed to investigate the effect of intravenously administered diclofenac sodium on the occurrence and severity of POST.