A Randomized, Double-Blinded Comparative Study of Pre-Operative Nebulized Dexamethasone and Intravenous Ketorolac Tromethamine for the Prevention of Post-Operative Sore Throat Following General Anesthesia

Abstract

Background: Postoperative sore throat (POST) is a common complication following endotracheal intubation during general anesthesia, affecting approximately 30–70% of surgical patients and contributing to postoperative discomfort and reduced patient satisfaction. Airway mucosal trauma and inflammatory responses triggered by laryngoscopy and endotracheal tube placement are the primary mechanisms responsible for this condition. Although various pharmacological interventions have been proposed to mitigate POST, comparative evidence evaluating topical corticosteroids and systemic non-steroidal anti-inflammatory drugs remains limited. Objective: To compare the effectiveness of preoperative nebulized dexamethasone and intravenous ketorolac tromethamine in reducing the severity of postoperative sore throat among adult patients undergoing surgery under general anesthesia with endotracheal intubation. Methods: A prospective, randomized, double-blind clinical trial was conducted on 100 patients (ASA I–III) undergoing surgery requiring endotracheal intubation. Participants were randomly assigned to receive either preoperative nebulized dexamethasone or intravenous ketorolac tromethamine. Postoperative sore throat severity was assessed using the STAT-10 scale at 2, 4, 6, and 12 hours following extubation. Continuous variables were compared using independent t-tests, while categorical variables were analyzed using chi-square tests. Multivariable logistic regression was performed to identify predictors of moderate-to-severe POST. Results: Patients receiving nebulized dexamethasone demonstrated significantly lower mean sore throat scores compared with the ketorolac group at 2 hours (3.2 ± 1.1 vs. 4.6 ± 1.3), 4 hours (2.6 ± 1.0 vs. 3.9 ± 1.2), 6 hours (1.9 ± 0.9 vs. 3.1 ± 1.1), and 12 hours (1.1 ± 0.7 vs. 2.0 ± 0.8), all p < 0.001. Moderate-to-severe POST was significantly more frequent in the ketorolac group during early postoperative assessments. Multivariable analysis identified treatment allocation (adjusted OR = 3.06, 95% CI: 1.36–6.87) and endotracheal tube size >7.5 mm (adjusted OR = 2.20, 95% CI: 1.07–4.54) as independent predictors of clinically significant POST. Conclusion: Preoperative nebulized dexamethasone significantly reduces postoperative sore throat severity compared with intravenous ketorolac following endotracheal intubation. Targeted topical anti-inflammatory therapy may represent an effective strategy for improving early postoperative airway comfort and patient satisfaction.