Postoperative sore throat: a systematic review

Postoperative sore throat is a common complaint with an incidence of up to 62%. While anaesthetists often perceive this as a minor and self-limiting complication, postoperative sore throat is one of the leading causes of postoperative anaesthesia-related discomfort. Preventative strategies for postoperative sore throat have been studied extensively, but well-evidenced recommendations are lacking.

We performed a systematic review to summarise interventions which may prevent postoperative sore throat. Two independent reviewers assessed studies against inclusion criteria and completed a Cochrane Risk of Bias 2 assessment for randomised controlled trials. The results were synthesised narratively due to extensive methodological heterogeneity (populations, interventions and outcomes).

We identified 1883 studies, of which 162 met the inclusion criteria (enrolling 21,199 patients). The pooled incidence of postoperative sore throat at 1 h was 32.4% (95%CI 26.9-38.5%) in 43 studies involving tracheal intubation and 29.4% (95%CI 20.5-40.2%) in 18 studies that used a supraglottic airway device. At 24 h, the pooled incidence of postoperative sore throat was 16.4% (95%CI 13.6-19.8%) in 93 studies involving tracheal intubation and 9.9% (95%CI 6.7-14.4%) in 23 studies that used supraglottic airway devices. Interventions with evidence of benefit included maintaining cuff pressure ≤ 60 cmH₂O for supraglottic airway devices and ≤ 30 cmH₂O for tracheal tubes. For tracheal tubes only, other interventions with benefit included use of topical ketamine; intravenous or topical steroids; and topical non-steroidal anti-inflammatory drugs.

Despite the high incidence of postoperative sore throat, the current literature lacks high-quality randomised controlled trials on treatments that prevent a complication that is of importance to patients and their recovery. New research will only add value to this area if studies adequately control for confounders.