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Postoperative sore throat has a reported incidence of up to 62% following general anaesthesia. In adults undergoing tracheal intubation, female sex, younger age, pre-existing lung disease, prolonged duration of anaesthesia and the presence of a blood-stained tracheal tube on extubation are associated with the greatest risk. Tracheal intubation without neuromuscular blockade, use of double-lumen tubes, as well as high tracheal tube cuff pressures may also increase the risk of postoperative sore throat. The expertise of the anaesthetist performing tracheal intubation appears to have no influence on the incidence in adults, although it may in children. In adults, the i-gel(™) supraglottic airway device results in a lower incidence of postoperative sore throat. Cuffed supraglottic airway devices should be inflated sufficiently to obtain an adequate seal and intracuff pressure should be monitored. Children with respiratory tract disease are at increased risk. The use of supraglottic airway devices, oral, rather than nasal, tracheal intubation and cuffed, rather than uncuffed, tracheal tubes have benefit in reducing the incidence of postoperative sore throat in children. Limiting both tracheal tube and supraglottic airway device cuff pressure may also reduce the incidence.

INTRODUCTION: Postoperative sore throat is a common complaint with an incidence of up to 62%. While anaesthetists often perceive this as a minor and self-limiting complication, postoperative sore throat is one of the leading causes of postoperative anaesthesia-related discomfort. Preventative strategies for postoperative sore throat have been studied extensively, but well-evidenced recommendations are lacking. METHODS: We performed a systematic review to summarise interventions which may prevent postoperative sore throat. Two independent reviewers assessed studies against inclusion criteria and completed a Cochrane Risk of Bias 2 assessment for randomised controlled trials. The results were synthesised narratively due to extensive methodological heterogeneity (populations, interventions and outcomes). RESULTS: We identified 1883 studies, of which 162 met the inclusion criteria (enrolling 21,199 patients). The pooled incidence of postoperative sore throat at 1 h was 32.4% (95%CI 26.9-38.5%) in 43 studies involving tracheal intubation and 29.4% (95%CI 20.5-40.2%) in 18 studies that used a supraglottic airway device. At 24 h, the pooled incidence of postoperative sore throat was 16.4% (95%CI 13.6-19.8%) in 93 studies involving tracheal intubation and 9.9% (95%CI 6.7-14.4%) in 23 studies that used supraglottic airway devices. Interventions with evidence of benefit included maintaining cuff pressure ≤ 60 cmH2O for supraglottic airway devices and ≤ 30 cmH2O for tracheal tubes. For tracheal tubes only, other interventions with benefit included use of topical ketamine; intravenous or topical steroids; and topical non-steroidal anti-inflammatory drugs. DISCUSSION: Despite the high incidence of postoperative sore throat, the current literature lacks high-quality randomised controlled trials on treatments that prevent a complication that is of importance to patients and their recovery. New research will only add value to this area if studies adequately control for confounders. Getting a sore throat after surgery is very common, happening in more than half of patients. Doctors often think of it as a small problem, but for patients, it can be very uncomfortable. Many studies have looked at ways to a stop sore throat after surgery, but we still don't have clear advice that works for everyone. We looked at many studies to see what treatments might help prevent a sore throat after surgery. Two researchers checked the studies carefully to make sure they were of good quality. Because the studies were all a bit different, we described the results using words instead of combining them into one big calculation. We found 1883 studies. Out of these, 162 were good enough to include; more than 21,000 patients took part in these studies. After 1 hour, about 32 out of 100 patients who had a breathing tube, and about 29 out of 100 who had a special airway mask, got a sore throat. After 24 hours, about 16 out of 100 with a breathing tube and about 10 out of 100 with a special airway mask still had a sore throat. Treatments that seemed to help reduce a sore throat included keeping the pressure in the airway tube or mask low. For breathing tubes, medicines such as ketamine, steroids or anti‐inflammatory drugs (given as sprays, creams or through a drip) also helped. Sore throat after surgery happens often, but we still don't have good research on how to stop it. Future studies need to be better planned and look at patient comfort while taking into account different factors.