Addition of antimicrobials to oral sprays containing nonsteroidal antiinflammatory drugs does not reduce the severity of postoperative sore throat: a prospective, randomized, placebo-controlled trial.

Background/aim: Postoperative sore throat (POST) is a common complication following general anesthesia that significantly affects patient satisfaction, prolongs recovery, and increases treatment costs. This study aimed to evaluate whether the addition of antimicrobial agents to NSAID-based oral sprays could enhance the preventive efficacy against POST. Materials and methods: In this prospective, randomized, placebo-controlled trial, 105 patients (ASA I-II; age 18-65 years) scheduled for elective ear surgery under general orotracheal anesthesia were enrolled. Patients were randomly allocated into three groups: a placebo group; a flurbiprofen oral spray group; and a group receiving an oral spray containing benzydamine hydrochloride, chlorhexidine digluconate, and cetylpyridinium chloride. The sprays were administered under direct laryngoscopy before intubation and after the final oropharyngeal aspiration. POST severity was assessed using a 10mm Visual Analog Scale (VAS) at 1 h, 6 h, 24 h, and 1 week postoperatively. Patients were also subgrouped based on surgical duration (<120 min vs. ≥120 min). Results: Both NSAIDbased treatments significantly reduced VAS scores at early postoperative time points compared to the placebo. In subgroup analysis, patients undergoing surgeries lasting less than 120 min exhibited lower VAS scores with both active treatments, while in those with surgeries ≥120 min, significant differences were noted at 1 and 6 h. No significant difference was found between the flurbiprofen spray and the combination spray. Conclusion: NSAIDcontaining oral sprays effectively reduce the severity of postoperative sore throat. However, the addition of antimicrobial agents does not provide extra analgesic benefit, suggesting that simpler, costeffective NSAID formulations may be preferable in clinical practice.