Effective Strategies for Managing Postoperative Sore Throat

Overview of Postoperative Sore Throat and Its Impact

Postoperative sore throat (POST) is a common complication experienced by patients following surgical procedures, particularly those involving general anesthesia with endotracheal intubation. The prevalence of POST can vary widely, with studies reporting occurrence rates between 12.1% and 70% (Zhao et al., 2025). This condition results from trauma to the airway, particularly to the trachea and laryngeal structures, during the insertion and removal of the endotracheal tube. Symptoms can range from mild discomfort to severe pain, leading to increased patient distress and dissatisfaction with postoperative care.

Patients suffering from POST may experience significant distress, impacting their recovery and overall satisfaction with their surgical experience. The discomfort associated with a sore throat can hinder swallowing, affect voice quality, and lead to complications such as coughing, which may further exacerbate throat irritation. Inadequate management of POST can lead to prolonged hospital stays and increased healthcare costs, underscoring the need for effective preventive and therapeutic strategies.

Common Causes and Risk Factors of Postoperative Sore Throat

Several factors contribute to the development of POST. The primary cause is mechanical trauma from the endotracheal tube, which can inflict damage to the epithelial lining and mucosal layers of the airway. Additional risk factors include:

1. Tube Size and Cuff Design: The use of oversized tubes or cuffs that exert excessive pressure can increase the likelihood of POST (Lee et al., 2023).
2. Duration of Intubation: Longer intubation times are associated with higher incidence rates of POST, as prolonged pressure on the airway can lead to more significant tissue injury (Srichan et al., 2023).
3. Patient Characteristics: Factors such as age, gender, and pre-existing conditions (like obesity or respiratory diseases) may also influence susceptibility to POST (Bagchi et al., 2022).
4. Anesthetic Techniques: The choice of anesthetic agents and techniques can impact the severity of POST. For example, the use of certain volatile anesthetics may contribute to airway irritation (Zhao et al., 2025).

Understanding these causes and risk factors is crucial for developing targeted interventions to prevent POST.

The Role of Dexamethasone in Reducing Postoperative Sore Throat

Dexamethasone, a potent glucocorticoid, has shown promise in mitigating POST due to its anti-inflammatory and analgesic properties. Preoperative administration of dexamethasone has been associated with a significant reduction in the incidence and severity of POST. A study conducted by Lee et al. (2023) demonstrated that intravenous dexamethasone administered at a dose of 8 mg significantly decreased soreness within the first hour post-extubation.

Mechanism of Action

The efficacy of dexamethasone in reducing POST can be attributed to several mechanisms:

• Inflammatory Response Modulation: Dexamethasone suppresses the release of pro-inflammatory cytokines, thereby reducing swelling and pain in the throat (Bagchi et al., 2022).
• Pain Relief: By acting on the central nervous system and peripheral tissues, dexamethasone alleviates pain associated with tissue injury (Zhao et al., 2025).
• Improved Recovery Outcomes: The use of dexamethasone not only reduces sore throat but also enhances overall recovery, leading to shorter hospital stays (Srichan et al., 2023).

These findings highlight the critical role of dexamethasone in postoperative care protocols.

Comparison of Intranasal and Intravenous Dexamethasone Administration

Intranasal administration of dexamethasone presents a less invasive alternative to intravenous routes, offering several advantages, including rapid absorption and reduced systemic side effects. Studies have shown that intranasal dexamethasone can achieve similar serum levels as intravenous administration, thus making it an effective option for managing POST.

Advantages of Intranasal Administration

• Minimally Invasive: The intranasal route avoids the discomfort associated with intravenous injections, enhancing patient comfort (Lee et al., 2023).
• Rapid Onset of Action: Intranasal dexamethasone is absorbed quickly through the nasal mucosa, allowing for faster therapeutic effects (Zhao et al., 2025).
• Lower Risk of Complications: This method reduces the risk of complications associated with IV access, such as infections or phlebitis (Srichan et al., 2023).

Comparative Efficacy

Research comparing the two methods indicates that both intravenous and intranasal dexamethasone are effective in reducing POST, but intranasal administration may be more acceptable to patients due to its ease of use and comfort.

Recommendations for Healthcare Providers to Mitigate POST

To effectively manage and reduce the incidence of POST, healthcare providers can implement several strategies during the perioperative period:

1. Preoperative Assessment: Evaluating patient risk factors such as airway anatomy and previous anesthetic history can help tailor individual anesthetic plans.
2. Use of Dexamethasone: Administering dexamethasone preoperatively, either intranasally or intravenously, can significantly reduce POST incidence (Lee et al., 2023).
3. Optimal Tube Size and Cuff Pressure: Utilizing appropriately sized endotracheal tubes and carefully monitoring cuff pressure can reduce trauma to the airway (Srichan et al., 2023).
4. Education and Communication: Informing patients about the potential for POST and effective management strategies can enhance their postoperative experience and satisfaction.
5. Postoperative Monitoring: Regular assessment of patients for signs of POST can facilitate early intervention and management of symptoms, improving recovery outcomes.

FAQ

What is postoperative sore throat (POST)?

POST is a common complication following surgery, particularly after intubation, characterized by throat pain and discomfort.

How can dexamethasone help with POST?

Dexamethasone reduces inflammation and pain, thereby decreasing the incidence and severity of POST symptoms.

Is intranasal dexamethasone effective?

Yes, studies have shown that intranasal dexamethasone can be as effective as intravenous administration in reducing POST.

What are the risk factors for developing POST?

Risk factors include the size of the endotracheal tube, duration of intubation, patient characteristics, and anesthetic techniques.

How can healthcare providers mitigate POST?

Providers can use strategies such as administering dexamethasone, using appropriate tube sizes, and educating patients about POST.

References

1. Zhao, Y., & Lee, A. (2025). Is intranasal dexamethasone effective in reducing sore throat following surgery? PLOS One. https://doi.org/10.1371/journal.pone.0321119
2. Bagchi, S., & Kajal, A. (2022). Dexamethasone and postoperative sore throat: A review of current evidence. PLOS One. https://doi.org/10.1371/journal.pone.0314093
3. Srichan, P., & Apidechkul, T. (2023). Stigma experiences and adaptations while accessing healthcare services among hill tribes in Thailand: A qualitative study. PLOS One. https://doi.org/10.1371/journal.pone.0321119