A randomized, double-blind comparison of licorice versus sugar-water gargle for prevention of postoperative sore throat and postextubation coughing.
BACKGROUND
One small study suggests that gargling with licorice before induction of anesthesia reduces the risk of postoperative sore throat. Double-lumen tubes are large and thus especially likely to provoke sore throats. We therefore tested the hypothesis that preoperative gargling with licorice solution prevents postoperative sore throat and postextubation coughing in patients intubated with double-lumen tubes.


METHODS
We enrolled 236 patients having elective thoracic surgery who required intubation with a double-lumen endotracheal tube. Patients were randomly assigned to gargle 5 minutes before induction of anesthesia for 1 minute with: (1) Extractum Liquiritiae Fluidum (licorice 0.5 g); or (2) Sirupus Simplex (sugar 5 g); each diluted in 30 mL water. Sore throat and postextubation coughing were evaluated 30 minutes, 90 minutes, and 4 hours after arrival in the postanesthesia care unit, and the first postoperative morning using an 11-point Likert scale by an investigator blinded to treatment.


RESULTS
The incidence of postoperative sore throat was significantly reduced in patients who gargled with licorice rather than sugar-water: 19% and 36% at 30 minutes, 10% and 35% at 1.5 hours, and 21% and 45% at 4 hours, respectively. The corresponding estimated treatment effects (relative risks) were 0.54 (95% CI, 0.30-0.99, licorice versus sugar-water; P = 0.005), 0.31 (0.14-0.68) (P < 0.001), and 0.48 (0.28-0.83) (P < 0.001).


CONCLUSIONS
Licorice gargling halved the incidence of sore throat. Preinduction gargling with licorice appears to be a simple way to prevent a common and bothersome complication.
From the Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Vienna Medical University, Vienna, Austria; and Departments of Quantatative Health Sciences and Outcomes Research, the Cleveland Clinic, Cleveland, Ohio.
Kurt
K
Ruetzler
Michael
M
Fleck
Sabine
S
Nabecker
Kristina
K
Pinter
Gordian
G
Landskron
Andrea
A
Lassnigg
Jing
J
You
Daniel I
DI
Sessler
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation / Q000009:adverse effects*; D000768:Anesthesia, General; D002241:Carbohydrates / Q000009:adverse effects / Q000627:therapeutic use*; D003371:Cough / Q000209:etiology* / Q000517:prevention & control*; D003422:Critical Care; D004311:Double-Blind Method; D005260:Female; D006035:Glycyrrhiza / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D010612:Pharyngitis / Q000209:etiology* / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D018401:Sample Size; D012996:Solutions / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
D002241:Carbohydrates; D012996:Solutions