Ketamine Gargle Peripheral Analgesic Effect on Sore Throat after Ear Surgery, a Randomized Clinical Trial


  • AliReza Salimi Department of Anesthesiology, Loghman Hospital, Shahid beheshti Medical University, Tehran
  • Fateme Haaji-Mohammadi
  • Afshar Etemadi Ale-Agha
  • Seyed Amir Mohajerani
  • Leyla Emami Borgheei
  • Latif Chachkar
  • Morteza Hashemian


gargle, ketamine, postoperative sore throat, topical analgesia


Background: Intubation could cause trauma to the airway mucosa which leads to postoperative sore throat with the incidence of 21-65%, which leads to other complications and patients’ dissatisfaction. Postoperative sore throat leads to morbidity particularly after head and neck and ear surgery and patient dissatisfaction.

Aim: to determine the effect of ketamine gargle on sore throat after intubation and to measure serum ketamine level.

Materials and methods: A prospective, randomized and placebo-controlled double blind study was conducted on 78 patients who underwent? ear surgery. The patients were randomized into three groups of 26 patients: The control group received 30ml normal saline as placebo and the experimental groups 40mg and 60 mg of ketamine in 30ml normal saline. Blood samples were obtained from the patients in order to measure serum ketamine level. Patients sore throat was assessed using visual analogue scale immediately after surgery, at arrival in the recovery unit, and at 2, 4 and 12 h after the surgery.

Results: The patients who received ketamine gargle (40 and 60 mg) had less sore throat at 0 and 2 h recovery than those who received placebo (<0.05). Sore throat was not significantly different in both groups received ketamine (p>0.05) while the ketamine level in blood in ketamine group was less than analgesic dose in both 40 and 60 mg groups.

Conclusion: ketamine gargle reduces sore throat after surgery and such effect is not caused by the blood absorption of ketamine.



Jensen PJ, Hommelgaard P, Søndergaard P, Eriksen S.Sore throat after operation: influence of tracheal intubation, intracuff pressure and type of cuff. Br J Anaesth. 1982 Apr;54(4):453-7.

Christensen AM, Willemoes-Larsen H, Lundby L, Jakobsen KB. Postoperative throat complaints after tracheal intubation. Br J Anaesth. 1994; 73: 786-7.

Tanaka Y, Nakayama T, Nishimori M, Sato Y, Furuya H.Lidocaine for preventing postoperative sore throat. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD004081.

McHardy FE, Chung F.Postoperative sore throat: cause, prevention and treatment. Anaesthesia. 1999 May;54(5):444-53.

Higgins PP, Chung F, Mezei G.Postoperative sore throat after ambulatory surgery.Br J Anaesth. 2002 Apr;88(4):582-4.

Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999; 89: 652-8.

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. Br J Anaesth. 2008 Feb;100(2):215-8.

Honarmand A, Safavi M. Beclomethasone inhaler versus intravenous lidocaine in the prevention of postoperative airway and throat complaints: a randomized, controlled trial. Ann Saudi Med. 2008 Jan-Feb;28(1):11-6.

Ozaki M, Minami K, Sata T, Shigematsu A. Transdermal ketoprofen mitigate the severity of postoperative sore throat. Can J Anaesth .2001; 48: 1080-3.

Navarro RM, Baughman VL. Lidocaine in the endotracheal tube cuff reduces postoperative sore throat. J Clin Anesth. 1997; 9: 394-7.

Combes X, Schauvliege F, Peyrouset O, et al. Intracuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia. Anesthesiology. 2001; 9 (55): 1120-4.

Al-Qahtani AS, Messahel FM.Quality improvement in anesthetic practice--incidence of sore throat after using small tracheal tube. Middle East J Anesthesiol. 2005 Feb;18(1):179-83.

el Hakim M. Beclomethasone prevents postoperative sore throat. Acta Anaesthesiol Scand. 1993 Apr; 37(3):250-2.

Ogata J, Minami K, Horishita T, et al. Gargling with sodium azulene sulfonate reduces the postoperative sore throat after intubation of the trachea. Anesth Analg. 2005; 101: 290-3.

Elhakim M, Siam A, Rashed I, Hamdy MH. Topical tenoxican from pharyngeal pack reduces postoperative sore throat. Acta Anaesthesiol Scand. 2000; 44: 733-6

Kati I, Tekin M, Silay E, Huseyinoglu UA, Yildiz H.Does benzydamine hydrochloride applied preemptively reduce sore throat due to laryngeal mask airway? Anesth Analg. 2004 Sep;99(3):710-2, table of contents.

Carlton SM, Coggeshall RE. Inflammation-induced changes in peripheral glutamate receptor populations. Brain Res. 1999; 820: 63-70.

Oczenski W, Krenn H, Dahaba AA, Binder M, El-Schahawi-Kienzl I, Kohout S, Schwarz S, Fitzgerald RD.Complications following the use of the Combitube, tracheal tube and laryngeal mask airway. Anaesthesia. 1999 Dec;54(12):1161-5

Carlton SM, Zhou S, Coggshall RE. Evidence for the interaction of glutamate and NK1 receptors in the periphery. Brain Res. 1998; 790: 160-9.

Davidson EM, Coggeshall RE, Carlton SM. Peripheral NMDA and non-NMDA glutamate receptors contribute to nociceptive behaviors in the rat formalin test. Neuroreport. 1997; 8: 941-6.

Oatway M, Reid A, Sawynok J. Peripheral antihyperalgesic and analgesic actions of ketamine and amitriptyline in a model of mild thermal injury in the rat. Anesth Analg. 2003; 97: 168-73 table of contents.

Clements JA, Nimmo WS, Grant IS. Bioavailability, pharmacokinetics, and analgesic activity of ketamine in humans. J Pharm Sci. 1982 May;71(5):539-42.

Chan L, Lee ML, Lo YL.Postoperative sore throat and ketamine gargle. Br J Anaesth. 2010 Jul;105(1):97.

Grant IS, Nimmo WS, Clements JA. Pharmacokinetics and analgesic effects of i.m. and oral ketamine. Br J Anaesth. 1981 Aug;53(8):805-10.

Canbay O, Celebi N, Sahin A, Celiker V, Ozgen S, Aypar U.Ketamine gargle for attenuating postoperative sore throat. Br J Anaesth. 2008 Apr;100(4):490-3.

Canbay O, Celebi N, Uzun S, Sahin A, Celiker V, Aypar U.Topical ketamine and morphine for post-tonsillectomy pain. Eur J Anaesthesiol. 2008 Apr;25(4):287-92.




How to Cite

Salimi, A., Haaji-Mohammadi, F., Ale-Agha, A. E., Mohajerani, S. A., Borgheei, L. E., Chachkar, L., & Hashemian, M. (2014). Ketamine Gargle Peripheral Analgesic Effect on Sore Throat after Ear Surgery, a Randomized Clinical Trial. Asian Journal of Pharmacy, Nursing and Medical Sciences, 2(3). Retrieved from




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