Early postoperative airway symptoms are increasingly recognized as important patient-centred outcomes under Enhanced Recovery After Surgery (ERAS) protocols and quality-of-recovery measures. Identifying a simple, inexpensive, and readily available intervention capable of reducing these symptoms has significant implications for routine anaesthesia practice, particularly in resource-limited settings. Endotracheal intubation is commonly used to secure the airway during general anaesthesia. However, it can cause airway injury due to direct contact between the tube and the airway mucosa. Postoperative Sore Throat (POST) is the second most common symptom following general anesthesia, after nausea and vomiting [1], occurring in 20–74% of patients [2,3]. It causes discomfort and may affect swallowing and speaking [4]. The severity ranges from mild to severe. POST has many causes. These include tube size [5], cuff pressure [6], use of double-lumen ETT [7], duration of laryngoscopy and intubation, duration of surgery, patient factors, and intubation technique [8,9]. Patients may also complain of cough and hoarseness. These symptoms add to patient discomfort, along with post-intubation morbidity. Many methods have been studied to reduce POST. These include changes in technique and various pharmacological approaches [10-15]. The application of topical agents to the endotracheal tube is commonly practiced; these agents act locally and have fewer systemic side effects [16,17]. Different agents such as local anaesthetics, steroids, and lubricants have been studied. However, most studies compare a single drug with a placebo, and there are limited direct comparisons between active agents. This study compares three agents applied to the endotracheal tube: 0.05% betamethasone gel, 2% lignocaine jelly, and plain water-based jelly. The aim is to compare their effect on postoperative sore throat.

A prospective randomized comparative study was conducted in 123 ASA I–II adult patients undergoing elective surgery under general anaesthesia with oral endotracheal intubation. Participants were randomly assigned to receive lubrication of the patient end of the endotracheal tube with either 0.05% betamethasone gel (Group B), 2% lidocaine jelly (Group L), or plain water-based jelly (Group P) (41 patients per group). Postoperative sore throat was assessed using a validated four-point grading scale at 1, 6, 12, and 24 hours after extubation. Patient Selection Criteria Inclusion Criteria 1. Patients belonging to the American Society of Anaesthesiologists physical status classes I and II. 2. Patients aged 18 years and above. 3. Patients who have given informed written consent. Exclusion Criteria 1. Patients undergoing general anaesthesia with nasal intubation. 2. Morbidly obese patients with anticipated difficult intubation. 3. Chronic smokers and patients having upper respiratory tract infections, or prior hoarseness and vocal issues, or those on steroid therapy. INTERVENTION PROTOCOL: Upon arrival in the operating theatre, patient identification was verified to ensure accuracy. • Baseline demographic data, including age, gender, weight, and medical history, were recorded for each patient. • Preoperative vital signs, like heart rate (HR), blood pressure (BP), and oxygen saturation (SpO2), were measured and documented. • Anaesthetic induction and maintenance protocols were standardized across all three groups. • B-group (Betamethasone gel group): where patients were intubated with an endotracheal tube lubricated with 0.05% Betamethasone gel. • L-group (Lidocaine jelly group): where patients were intubated with an endotracheal tube lubricated with 2% lidocaine jelly. • P-group (Plain jelly group): where patients were intubated with an endotracheal tube lubricated with water-based plain jelly. • Endotracheal tube cuff inflation was performed using the standard pilot balloon palpation technique, as cuff manometry was not available. Although this method is commonly used in clinical practice, it may lead to variability in cuff pressure and deviation from the recommended range of 20–30 mmHg. To minimise this variability, cuff inflation was standardised by using the minimal occlusive volume technique. However, the possibility of cuff pressure variation cannot be ruled out and may confound the relationship with postoperative airway morbidity. • Assessment of postoperative sore throat was carried out at 1,6,12 and 24 hours after surgery using a grading system for the severity of sore throat. • Postoperative airway complications were assessed using a standardised evaluation method. The incidence and severity of postoperative sore throat (POST) were recorded at 1, 6, and 24 hours after extubation & the severity was graded using a validated four-point scale. • Scoring Criteria for sore throat Score Description 0 No sore throat 1 Mild sore throat 2 Moderate sore throat 3 Severe sore throat Ethical Considerations Written informed consent was obtained from all participants.

The study groups were comparable with respect to age, sex, ASA physical status, and perioperative characteristics. Topical betamethasone demonstrated superior efficacy during the early postoperative period. Table 1: POST grade distribution at 1-hour post-extubation: POST Grade Group BG (n=41) Group LG (n=41) Group PG (n=41) p-value Grade 0 (Absent) 8 (19.5%) 1 (2.4%) 2 (4.9%) 0.014 Grade 1 (Mild) 25 (61.0%) 25 (61.0%) 17 (41.5%) 0.123 Grade 2 (Moderate) 7 (17.1%) 15 (36.6%) 22 (53.7%) 0.003 Grade 3 (Severe) 1 (2.4%) 0 (0.0%) 0 (0.0%) 0.365 POST Present (≥G1) 33 (80.5%) 40 (97.6%) 39 (95.1%) 0.014 Figure 1: POST grade distribution at 1-hour post-extubation At 1-hour post-extubation, the incidence of POST was 33 (80.5%) in Group BG, 40 (97.6%) in Group LG, and 39 (95.1%) in Group PG. The difference was statistically significant (χ² = 8.586, p = 0.014), demonstrating that betamethasone gel significantly reduced early POST. Notably, 8 patients (19.5%) in Group BG had no sore throat at 1 hour, compared with only 1 (2.4%) in Group LG and 2 (4.9%) in Group PG. Grade 2 POST was considerably higher in Groups LG (36.6%) and PG (53.7%) compared to Group BG (17.1%), reflecting the superior anti-inflammatory efficacy of betamethasone gel from the earliest time point. Table 2: POST grade distribution at 6 hours post-extubation: POST Grade Group BG (n=41) Group LG (n=41) Group PG (n=41) p-value Grade 0 (Absent) 24 (58.5%) 10 (24.4%) 5 (12.2%) <0.001 Grade 1 (Mild) 15 (36.6%) 29 (70.7%) 35 (85.4%) <0.001 Grade 2 (Moderate) 2 (4.9%) 2 (4.9%) 1 (2.4%) 0.812 Grade 3 (Severe) 0 (0.0%) 0 (0.0%) 0 (0.0%) N/A POST Present (≥G1) 17 (41.5%) 31 (75.6%) 36 (87.8%) <0.001 Figure 2: POST grade distribution at 6-hour post-extubation By 6 hours post-extubation, a highly significant difference in POST incidence was observed among the groups (χ² = 21.852, p < 0.001). Group BG showed a substantial decline in POST to 17 (41.5%), while Groups LG and PG maintained high incidence at 31 (75.6%) and 36 (87.8%), respectively. The proportion of patients with Grade 0 (no sore throat) was 58.5% in Group BG versus only 24.4% and 12.2% in Groups LG and PG, confirming the sustained protective effect of 0.05% betamethasone gel. Grade 2 POST was minimal across all groups at this time point (4.9%, 4.9%, 2.4%), suggesting that severe sore throat had largely resolved by 6 hours. Table 3: POST grade distribution at 12 hours post-extubation: POST Grade Group BG (n=41) Group LG (n=41) Group PG (n=41) p-value Grade 0 (Absent) 32 (78.0%) 27 (65.9%) 27 (65.9%) 0.380 Grade 1 (Mild) 8 (19.5%) 14 (34.1%) 14 (34.1%) 0.243 Grade 2 (Moderate) 1 (2.4%) 0 (0.0%) 0 (0.0%) 0.365 Grade 3 (Severe) 0 (0.0%) 0 (0.0%) 0 (0.0%) N/A POST Present (≥G1) 9 (22.0%) 14 (34.1%) 14 (34.1%) 0.380 Figure 3: POST grade distribution at 12-hour post-extubation At 12 hours post-extubation, POST incidence continued to decline: 9 (22.0%) in Group BG versus 14 (34.1%) each in Groups LG and PG. Although the absolute difference favoured Group BG, the intergroup comparison did not reach statistical significance (χ² = 1.933, p = 0.380). Grade 2 POST was absent in all three groups at this time point. The convergence of LG and PG (both 34.1%) suggests that the surface analgesic effect of lignocaine jelly had dissipated by 12 hours, with both groups now reflecting the natural resolution course, while betamethasone continued to provide superior protection through its anti-inflammatory mechanism. Table 4: POST grade distribution at 24 hours post-extubation POST Grade Group BG (n=41) Group LG (n=41) Group PG (n=41) p-value Grade 0 (Absent) 36 (87.8%) 37 (90.2%) 38 (92.7%) 0.758 Grade 1 (Mild) 5 (12.2%) 4 (9.8%) 3 (7.3%) 0.758 Grade 2 (Moderate) 0 (0.0%) 0 (0.0%) 0 (0.0%) N/A Grade 3 (Severe) 0 (0.0%) 0 (0.0%) 0 (0.0%) N/A POST Present (≥G1) 5 (12.2%) 4 (9.8%) 3 (7.3%) 0.758 Figure 4: POST grade distribution at 24-hour post-extubation At 24 hours post-extubation, POST incidence was 5 (12.2%) in Group BG, 4 (9.8%) in Group LG, and 3 (7.3%) in Group PG. The intergroup difference was not statistically significant (χ² = 0.554, p = 0.758). All residual POST at 24 hours was Grade 1 (mild) across all groups, with no moderate or severe sore throat persisting. The convergence of all three groups at 24 hours is consistent with the natural resolution of tracheal mucosal irritation over time and indicates that while the temporal course of POST resolution differed significantly between groups (particularly at 1 and 6 hours), the 24-hour endpoint showed comparable final recovery rates. Table 5: Summary of POST incidence across all timepoints among three groups: Time point Group BG (n=41) Group LG (n=41) Group PG (n=41) p-value 1 hour 33 (80.5%) 40 (97.6%) 39 (95.1%) 0.014* 6 hours 17 (41.5%) 31 (75.6%) 36 (87.8%) <0.001* 12 hours 9 (22.0%) 14 (34.1%) 14 (34.1%) 0.380 24 hours 5 (12.2%) 4 (9.8%) 3 (7.3%) 0.758 *Statistically significant (p<0.05) Figure 5: POST incidence trends across all timelines among three groups Table 5 and Fig. 5 summarise the complete POST incidence profile across all four timepoints. Group BG demonstrated significantly lower POST incidence at 1 hour (80.5% vs 97.6% in LG and 95.1% in PG; p = 0.014) and at 6 hours (41.5% vs 75.6% and 87.8%; p < 0.001). The steepest decline from 1 to 6 hours occurred in Group BG (80.5% → 41.5%, a 39-percentage-point drop), compared to 97.6% → 75.6% in Group LG (22 pp) and 95.1% → 87.8% in Group PG (7.3 pp). At 12 and 24 hours, all three groups converged with comparable incidence and no statistically significant differences. These findings confirm that 0.05% betamethasone gel provides significant and early protection against POST, with its greatest advantage in the 0–6-hour window following endotracheal extubation.

Postoperative sore throat (POST) was recognized as a common complication of tracheal intubation by the 1970s. [18] The best topical medication for preventing postoperative sore throat (POST) is still unknown, even though several strategies have been investigated. Prior research has mostly assessed lubricating gels, lignocaine, or corticosteroids separately versus placebo groups, with little direct comparison between active treatments. Furthermore, it is unclear how pharmaceutical activity and basic lubrication contribute to the reduction of POST. Thus, to assess their relative efficacy in avoiding postoperative sore throat and associated airway symptoms after endotracheal intubation, we compared 0.05% betamethasone gel, 2% lignocaine jelly, and ordinary water-based jelly. The study groups were comparable with respect to baseline characteristics, indicating that the observed differences were attributable to the study intervention. At 1 hour, betamethasone gel significantly reduced POST compared with lignocaine and plain jelly. Honarmand and Safavi (2008) [12] similarly reported a POST incidence of 19% with betamethasone gel versus 45% with lignocaine jelly and 62% with saline gel at 1-hour in a study of 120 patients. The superior early effect of betamethasone is likely related to its anti-inflammatory action. At 6 hours, betamethasone continued to demonstrate the greatest reduction in POST. This finding is in concordance with Kaki et al. (2009) [19], who reported significantly lower POST scores with betamethasone gel at 6 hours compared to lignocaine-filled cuff and plain gel controls. El-Seify et al. (2006) [20] similarly noted the most prominent difference between betamethasone and control groups at 6 hours, attributing it to the sustained anti-inflammatory activity of the steroid. At 12 hours, the incidence of POST declined in all groups, with no statistically significant difference. Honarmand and Safavi (2008) reported 12-hour POST rates of approximately 7.5% (BG), 30.0% (LG), and 50.0% (PG), showing significant differences persisting at 12 hours in their cohort. El-Seify et al. (2006) reported 10.0% (BG), 36.7% (LG), and 46.7% (PG). By 24 hours, POST was minimal in all groups, reflecting the natural resolution of airway inflammation. In contrast, Honarmand and Safavi (2008) reported sustained significant differences at 24 hours (7.5%, 27.5%, 45.0% for BG, LG, PG, respectively), as did El-Seify et al. (2006) (8.3%, 30.0%, 40.0%) and Kaki et al. (2009) (13.3%, 26.7%, 40.0%). Overall, the present study demonstrates that 0.05% betamethasone gel is more effective than 2% lignocaine jelly and plain water-based jelly in reducing early postoperative sore throat, with the maximum benefit observed during the first six postoperative hours.

Among the three topical agents evaluated, 0.05% betamethasone gel was the most effective in reducing the incidence and severity of early postoperative sore throat following endotracheal intubation. The greatest benefit was observed within the first six postoperative hours, while symptom resolution became comparable across groups by 24 hours. These findings support the preferential use of topical betamethasone gel as an effective prophylactic strategy for minimizing early postoperative airway complications. While lignocaine jelly offers transient surface analgesia, it does not address the underlying inflammatory cascade that comes with POST, explaining its inferior performance. Lignocaine jelly provided moderate benefit through local anaesthetic and lubricating effects, while plain jelly acted as a mechanical lubricant with comparatively lesser effect on inflammatory symptoms.

1. Lehmann M, Monte K, Barach P, Kindler CH. Postoperative patient complaints: a prospective interview study of 12,276 patients. J Clin Anesth. 2010;22(1):13-21. 2. Moulder ZJ, Mann J, Bramley P, Heinz J, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia. 2026;81:116-133. doi:10.1111/anae.70048. 3. Obsa MS, Adem AO, Bancha B, Gelgelu TB, Gemechu AD, Tilla M, Nugusse MA, Wosene NG, Gobena N, Hamu A, Abdulkadir S. Global incidence and risk factors of post-operative sore throat among patients who underwent surgery: a systematic review and meta-analysis. International Journal of Surgery Open. 2022 Oct 1;47:100536 4. Biro P, Seifert B, Pasch T. Complaints of sore throat after tracheal intubation: a prospective evaluation. Eur J Anaesthesiol. 2005;22(4):307-11. 5. Hu B, Bao R, Wang X, Liu S, Tao T, Xie Q, Yu X, Li J, Bo L, Deng X. The size of endotracheal tube and sore throat after surgery: a systematic review and meta-analysis. PLoS One. 2013;8(10):e74467. 6. Saeki H, Morimoto Y, Yamashita A, Nagusa Y, Shimizu K, Oka H, Miyauchi Y. [Postoperative sore throat and intracuff pressure: comparison among endotracheal intubation, laryngeal mask airway and cuffed oropharyngeal airway]. Masui. 1999;48(12):1328-31. Japanese. 7. Bihani P, Das D, Jaju R, et al. Postoperative sore throat following double-lumen tube insertion in adults undergoing surgery: a scoping review. J Cardiothorac Vasc Anesth. 2025;40:355-363. 8. El‐Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia. 2016 Jun;71(6):706-17. 9. Mitobe Y, Yamaguchi Y, Baba Y, Yoshioka T, Nakagawa K, Itou T, Kurahashi K. A literature review of factors related to postoperative sore throat. Journal of Clinical Medicine Research. 2022 Feb 24;14(2):88. 10. McHardy FE, Chung F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia. 1999 May;54(5):444-53. 11. Sumathi PA, Shenoy T, Ambareesha M, Krishna HM. Controlled comparison between betamethasone gel and lidocaine jelly applied over tracheal tube to reduce postoperative sore throat, cough, and hoarseness of voice. British journal of anaesthesia. 2008 Feb 1;100(2):215-8. 12. Honarmand A, Safavi M. Beclomethasone inhaler versus intravenous lidocaine in the prevention of postoperative airway and throat complaints: a randomized, controlled trial. Annals of Saudi Medicine. 2008 Jan;28(1):11-6. 13. Ki S, Myoung I, Cheong S, Lim S, Cho K, Kim MH, Han Y, Oh M, Park Y, Kim K, Lee J. Effect of dexamethasone gargle, intravenous dexamethasone, and their combination on postoperative sore throat: a randomized controlled trial. Anaesthesia and Pain Medicine. 2020 Oct 30;15(4):441-50. 14. Agarwal N, Gupta P, Moin K, Bijarnia I. Evaluation of Post-Operative Sore Throat Using Standard Versus Smaller-Sized Cuffed Endotracheal Tubes in Patients Undergoing Laparoscopic Surgeries. International Journal of Medical and Pharmaceutical Research. 2025 Nov 16;6:368-73. 15. Kim DH, Park JS. The effect of saline gargling on dry mouth and sore throat in patients with thyroidectomy. 16. Doukumo DM, Faponle AF, Bolaji BO, Adenekan AT, Olateju SO. Effects of lidocaine and ky jellies on sore throat, cough, and hoarseness following endotracheal anaesthesia. Journal of the west African college of surgeons. 2011 Jul;1(3):44. 17. Srinivasa B. Comparison Between Betamethasone Gel, Lidocaine Jelly and Lubricating Jelly Applied over Endotracheal Tube to Reduce Post Operative Sore Throat, Cough and Hoarseness of Voice (Doctoral dissertation, Rajiv Gandhi University of Health Sciences (India)). 18. Jeon WJ, Cho SY, Baek SJ, Kim KH. Small endotracheal tube cuff pressure changes and postoperative pharyngolaryngeal complications. J Int Med Res. 2011;39(5):1836-45. 19. Kaki AM, Almarakbi WA, Fawzi HM, Alhashemi JA. Use of lidocaine, betamethasone, or lidocaine-betamethasone mixture as endotracheal tube cuff filling agents. Saudi J Anaesth. 2009;3(2):61-65. 20. El-Seify ZA, Khattab AM, Shaaban AA, et al. Betamethasone gel applied to the tracheal tube decreases postoperative sore throat. Br J Anaesth. 2006;96(6):754-757