A randomized prospective study comparing intracuff dexmedetomidine and alkalinized lidocaine for the prevention of postoperative sore throat, hoarseness, and cough in prolonged prone-position spine surgery.

BACKGROUND

Tracheal intubation is essential for securing the airway during general anesthesia but often results in postoperative sore throat (POST), hoarseness, and coughing, with reported incidences reaching ~65%, ~55%, and ~96%, respectively. These complications arise mainly from irritation, inflammation, and mechanical trauma caused by the endotracheal tube, particularly during prone-position procedures. Their severity depends on factors such as tube size, cuff pressure, and intubation duration. Preventive approaches include optimizing cuff pressure and using anti-inflammatory or local anesthetic agents. This study evaluated whether intracuff dexmedetomidine offers an advantage over alkalinized lidocaine in reducing POST during prolonged prone-position surgeries.

PATIENTS AND

METHODS

In this prospective randomized study, 100 adult patients (aged 18-65 years, American Society of Anesthesiologists I-II) undergoing thoracolumbar spine surgery under general anesthesia between March and October 2025 were allocated to two groups: Group D received 4 mL of intracuff dexmedetomidine (4 µg/mL), and Group AL received 4 mL of 2% alkalinized lidocaine. Primary outcomes included the incidence and severity of POST, hoarseness, and pain assessed in the Post-Anesthesia Care Unit, and at 2 and 24 h postsurgery. Secondary outcomes included hemodynamic and procedural parameters.

RESULTS

Both groups were comparable in demographic and clinical variables. No statistically significant differences were found in POST incidence, hoarseness, pain scores, or hemodynamic measures, though dexmedetomidine showed a slight trend toward better symptom prevention.

CONCLUSION

Intracuff dexmedetomidine provided a modest improvement over alkalinized lidocaine in reducing postextubation sore throat, hoarseness, and postoperative pain during prolonged prone-position spine surgery.