Postoperative sore throat (POST) is one of the most common minor complications following general anaesthesia with endotracheal intubation. Its reported incidence ranges between 30% and 70%, depending on patient characteristics, airway technique, and duration of intubation [1,2]. Although not life-threatening, POST significantly affects patient comfort, satisfaction, and early postoperative recovery [3].

The pathophysiology of POST is multifactorial. Mechanical trauma during laryngoscopy, cuff pressure–related mucosal ischemia, tube size, repeated intubation attempts, and prolonged duration of intubation are established contributing factors [2,4]. In elderly patients, age-related epithelial thinning, decreased mucosal elasticity, and comorbid conditions increase susceptibility to mucosal injury. Additionally, anatomical changes such as reduced cervical mobility, edentulous status, and higher Mallampati grading often make intubation more challenging and prolonged in this population, further increasing POST risk.

Lubrication of the endotracheal tube (ETT) is a commonly used preventive strategy. Plain water-based lubricants reduce friction during insertion, while lignocaine-containing jelly theoretically provides local anaesthetic effect, potentially reducing mucosal irritation and cough reflex [1]. However, evidence regarding the efficacy of lignocaine jelly remains inconsistent.

A systematic review by El-Boghdadly et al. reported that local anaesthetic lubrication does not consistently reduce POST and may even increase mucosal irritation in some cases [2]. Similarly, the Cochrane review by Tanaka et al. found insufficient evidence supporting the routine use of topical lidocaine for POST prevention [1]. Some studies have even suggested that lidocaine jelly may exacerbate postoperative airway symptoms [5].

Given that elderly patients frequently experience difficult intubation and prolonged laryngoscopy time, their baseline risk of POST may be higher than younger adults. Therefore, it is clinically relevant to evaluate whether lignocaine jelly offers additional benefit in this subgroup.

This study aims to compare the incidence and severity of POST in elderly patients undergoing general anaesthesia with endotracheal intubation using lignocaine jelly versus plain lubricating jelly.

This prospective randomized controlled study was conducted after institutional ethical approval. Sixty elderly patients aged 50-60 years, ASA physical status I–III, undergoing elective surgery (<4 hours duration) under general anaesthesia with orotracheal intubation were included.

Exclusion Criteria

• Upper respiratory tract infection
• Bronchial asthma
• Anticipated difficult airway requiring advanced airway devices
• Surgeries involving oral cavity or pharynx
• More than two intubation attempts

Patients were randomly allocated into two equal groups (n=30 each):

• Group LI: Endotracheal tube lubricated with 2.5 mL of 2% lignocaine jelly
• Group LU: Endotracheal tube lubricated with 2.5 mL of plain KY jelly

Standardized anaesthesia protocol was followed in all patients. Laryngoscopy was performed by an experienced anaesthesiologist. Intubation attempts and duration of laryngoscopy (from insertion of laryngoscope to confirmation of ETT placement) were recorded.

Cuff pressure was maintained between 20–25 cm H₂O using a manometer.

Outcome Measures

POST score was assessed at 1, 6, 12, and 24 hours post-extubation using a 4-point scale:

• Grade 0: No sore throat
• Grade 1: Mild (on questioning)
• Grade 2: Moderate (spontaneous complaint)
• Grade 3: Severe (hoarseness/voice change)

The assessor was blinded to group allocation.

Statistical analysis was performed using SPSS version 26. Continuous variables were analyzed using independent t-test; categorical variables were analyzed using chi-square test. A p-value <0.05 was considered statistically significant.

Table 1. Demographic Characteristics and Intubation Variables

Demographic characteristics were comparable between groups. The study population consisted predominantly of elderly patients.. Intubation duration was relatively prolonged compared to younger cohorts reported in literature, reflecting anticipated airway challenges in elderly patients. In mean intubation attempts and duration differences were not statistically significant (p>0.05). Table 1

Table 2. Incidence of POST (%)

POST incidence was consistently higher in the lignocaine group across all time intervals. Statistically significant differences were observed at 6 hours and 12 hours post-extubation. The LU group demonstrated faster symptom resolution. At 24 hours, incidence declined in both groups, though LU group maintained lower percentages. Table 2

Table 3. Mean POST Scores

Mean POST scores were significantly higher in the lignocaine group at 6 and 12 hours. The LU group exhibited milder symptom intensity. No severe (Grade 3) sore throat was recorded in either group. Table 3

Table 4. Association of Intubation Duration (>150 min) with POST

Prolonged intubation duration was significantly associated with higher POST incidence. Elderly patients with intubation duration exceeding 150 minutes showed increased sore throat occurrence. This supports the hypothesis that mucosal compression time contributes to airway morbidity. Table 4

Postoperative sore throat (POST) continues to be one of the most frequently reported airway-related complications after general anaesthesia with endotracheal intubation. Although often categorized as minor, it significantly influences patient comfort, early oral intake, and overall perioperative satisfaction. In the present study conducted exclusively in elderly patients, lignocaine jelly did not demonstrate superiority over plain lubricating jelly in reducing either the incidence or severity of POST.

The overall incidence observed in our study (20–40% within the first 12 hours) is consistent with previously reported data. Lee et al. [7] reported that postoperative airway discomfort remains common even when multimodal perioperative strategies are used. Elderly patients may be particularly susceptible due to age-related epithelial thinning, reduced mucosal hydration, and diminished tissue elasticity. These structural alterations increase vulnerability to mechanical trauma during laryngoscopy and cuff-related compression.

Tube-related factors are well established contributors to POST. In a systematic review and meta-analysis, Hu et al. [8] demonstrated that larger endotracheal tube (ETT) diameters significantly increase the risk of sore throat. Although ETT size was standardized in our study, elderly patients often have relatively smaller airway calibers, potentially predisposing them to mucosal compression even with conventional tube sizes. Furthermore, cuff characteristics play an important role. Chang et al. [9] showed that cuff shape and pressure distribution significantly influence postoperative airway morbidity, with certain cuff designs creating localized high-pressure zones that increase mucosal injury risk. In our study, cuff pressure was carefully maintained between 20–25 cm H₂O to eliminate pressure variability as a confounder.

Duration of intubation emerged as a significant risk factor in our cohort. Patients intubated for more than 150 minutes showed higher POST incidence. This observation aligns with findings by Sato et al. [10], who reported that sustained intracuff pressure and prolonged mucosal contact are associated with increased postoperative throat discomfort. In elderly individuals, compromised mucosal perfusion may amplify the ischemic effect of prolonged compression, thereby intensifying inflammatory response.

The effectiveness of lignocaine jelly remains controversial. A comprehensive review by McHardy and Chung [11] concluded that topical local anaesthetic application to the ETT does not consistently reduce POST incidence. Our results are in agreement with this conclusion. Despite its theoretical benefit of reducing nociceptive transmission, lignocaine jelly did not show significant protective effect and was associated with higher mean sore throat scores at intermediate time intervals (6 and 12 hours).

Inflammatory mechanisms appear to play a central role in POST pathogenesis. Kazemi and Amini [12] demonstrated that betamethasone gel significantly reduced both incidence and severity of POST compared to KY jelly, highlighting the importance of anti-inflammatory modulation rather than neural blockade alone. Lignocaine provides temporary anaesthesia but does not attenuate inflammatory cascade triggered by mechanical trauma. This may explain the absence of sustained benefit in our findings.

Direct comparison between plain KY jelly and lignocaine jelly has been reported previously. Doukumo et al. [13] observed that KY jelly was comparable or slightly superior to lignocaine jelly in reducing POST, although statistical significance was not consistent across all time points. Our findings mirror this trend, with plain lubricating jelly showing lower incidence and significantly lower severity scores at 6 and 12 hours post-extubation.

Airway manipulation difficulty is another recognized determinant. Park et al. [14] identified repeated intubation attempts and prolonged laryngoscopy as independent predictors of POST. Although patients with anticipated difficult airways were excluded in our study, elderly anatomical factors such as reduced cervical mobility and edentulous status often contribute to increased laryngoscopy time. This may partially explain the moderate incidence observed even with standardized technique.

Systemic prophylaxis has shown promise. Lee et al. [15] demonstrated that perioperative dexamethasone combined with paracetamol significantly reduced POST incidence. Their findings further support the hypothesis that inflammatory modulation is more effective than topical anaesthetic application. In contrast, our study isolated the lubricant variable, thereby clarifying that lignocaine jelly alone does not provide meaningful protective benefit in elderly patients.

Taken together, current evidence and our findings suggest that plain lubricating jelly is at least equally effective, if not superior, to lignocaine-containing jelly for prevention of POST in elderly patients. The lack of consistent benefit with lignocaine and potential for mucosal irritation argue against its routine use. Instead, emphasis should be placed on optimal tube size selection, careful cuff pressure monitoring, minimizing intubation duration, and adopting gentle airway techniques. Further large-scale studies focusing specifically on geriatric airway physiology may help refine preventive strategies for this growing surgical population

In elderly patients undergoing general anaesthesia with endotracheal intubation, plain lubricating jelly demonstrated comparable or superior efficacy in reducing postoperative sore throat compared to 2% lignocaine jelly. Significant reductions in incidence and severity were observed at 6 and 12 hours in the plain jelly group. Prolonged intubation duration was independently associated with increased POST. The routine use of lignocaine jelly over endotracheal tubes in elderly patients cannot be recommended based on current evidence. Emphasis should instead be placed on gentle airway manipulation, optimal cuff pressure control, and minimizing intubation duration. Larger multicentric studies are recommended to further validate these findings

1. Tanaka Y, Nakayama T, Nishimori M, Sato Y, Furuya H. Lidocaine for preventing postoperative sore throat. Cochrane Database Syst Rev. 2009;3:CD004081.
2. El-Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia. 2016;71(6):706-717.
3. Lehmann M, Monte K, Barach P, Kindler CH. Postoperative patient complaints. J Clin Anesth. 2010;22(1):13-21.
4. Mitobe Y, Yamaguchi Y, Baba Y, et al. Factors related to POST. J Clin Med Res. 2022;14(2):88-94.
5. Kori K, Muratani T, et al. Lidocaine jelly and POST. Masui. 2004;53:767-771.
6. Saeki H, Morimoto Y, et al. Intracuff pressure and POST. Masui. 1999;48:1328-1331.
7. Lee J, Park HP, et al. Dexamethasone reduces POST. J Anesth. 2017;31:869-877.
8. Winkel E, Knudsen J. Cinchocaine jelly. Anesth Analg. 1971;50:92-94.
9. Hu B, Bao R, Wang X, et al. ETT size and sore throat. PLoS One. 2013;8:e74467.
10. Chang JE, Kim H, Han SH, et al. Cuff shape and POST. Anesth Analg. 2017;125:1240-1245.
11. Sato K, Tanaka M, Nishikawa T. Intracuff pressure changes. Masui. 2004;53:767-771.
12. McHardy FE, Chung F. POST review. Can J Anaesth. 1999;46:13-17.
13. Kazemi A, Amini A. Betamethasone gel and POST. Anesth Analg. 2007;104:1281-1283.
14. Doukumo DM, et al. KY vs lignocaine jelly. Niger J Clin Pract. 2018;21:1155-1160.
15. Park SY, Kim SH. Risk factors for POST. Korean J Anesthesiol. 2019;72:108-115.