Corticosteroids applied on endotracheal tubes to prevent postoperative sore throat: A metaanalysis

Learning Objectives: Postoperative sore throat is a common complication of general anesthesia. Given an emphasis on the quality of patients' postoperative recovery today, preventing postoperative sore throat is important. Numerous randomized trials have been undertaken to examine the efficacy of topical corticosteroids to prevent postoperative sore throat. However, no systematic views have summarized the data on this topic. Herein, we conducted a meta-analysis to assess the efficacy of corticosteroids applied on endotracheal tubes to prevent postoperative sore throat. Methods: We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Wanfang Database, the China Academic Journal Network Publishing Database, and Web of Science without language restrictions. We included randomized trials that compared topical corticosteroids applied on endotracheal tubes with controls and lidocaine, respectively, to prevent postoperative sore throat in patients undergoing surgery under general anesthesia. Our primary outcome was the incidence of postoperative sore throat at 24 hours after the surgery. We pooled the data using a random-effects model. Trial sequential analyses were conducted using the O'Brien-Fleming method of alpha-spending function to examine the robustness of our findings against type 1 or type 2 error. We assessed the quality of evidence using the GRADE system. Results: Seventeen trials involving 1821 participants were included. Compared with controls (agents without analgesic potency), corticosteroids applied on endotracheal tubes were associated with a significant reduction in the incidence of postoperative sore throat (RR 0.41; 95% CI, 0.27 to 0.62). Compared with lidocaine, topical corticosteroids were associated with a significant reduction in the incidence of postoperative sore throat (RR 0.42; 95% CI, 0.32 to 0.55). Trial sequential analyses demonstrated that it is unlikely that these results are due to a Type 1 error, suggesting a true positive effect of corticosteroids applied on endotracheal tubes, in comparison with either controls or lidocaine. Evidence for both comparisons was graded as high-quality. Conclusions: Our meta-analyses suggested that corticosteroids applied on endotracheal tubes are associated with 59% and 58% reduction in the incidence of postoperative sore throat, compared with control and lidocaine, respectively. Our study provides a high-quality evidence for a new option with a proven efficacy to prevent postoperative sore throat.