Comparative study between oral acetaminophen and lidocaine spray on endotracheal tube-related sore throat in adult intensive care

Background/Purpose: Endotracheal tube (ETT)-related sore throat is a common source of stress in intensive care. Quantitative studies on therapy for ETT-related sore throat remain limited. The current study evaluated the therapeutic effects of oral acetaminophen (ACT) and lidocaine (LIDO) spray on pain relief for ETT-related sore throat in intensive care.

Methods: Patients who could communicate with caregivers non-verbally and who had acquired ETT-related sore throat at a medical intensive care unit (ICU) were enrolled. The medications were dispensed at the request of the patients. The intensity of ETT-related throat pain was recorded for quantitative comparison before and after patients received 500 mg of ACT orally or one dose of 10% LIDO spray locally. Before leaving the ICU, the patients were interviewed by a research nurse to assess the effect of these interventions on satisfaction with pain management for ETT-related sore throat.

Results: We enrolled 89 patients during the study period, and the intensity of ETT-related throat pain significantly decreased after treatment (6.97 in 5 min before vs. 3.60 in 120 min after oral ACT, P < 0.001; 8.56 in 5 min before vs. 4.12 in 120 min after LIDO application, P < 0.001). The degree of pain reduction over time differed between the ACT and LIDO groups. Patients in the LIDO group made more requests for additional therapy compared with patients in the ACT group (1 LIDO spray per request for an average of 4.7 requests vs. 1 ACT dose per request for an average of 1.3 requests, P < 0.001). Patients in both the ACT and LIDO groups reported high satisfaction with pain management for ETT-related sore throat (87.3 of 100 vs. 86.5 of 100, respectively, P = 0.805).

Conclusion: ACT and LIDO treatment can effectively attenuate ETT-related sore throat. Patients were highly satisfied with pain management for ETT-related sore throat after both oral ACT and local LIDO application.

Endotracheal tube; Intensive care; Pain management; Quality of care

[1] Curtis JR. Caring for patients with critical illness and their families: the value of the integrated clinical team. Respiratory Care. 2008; 53: 480-487.

[2] Novaes MAFP, Knobel E, Bork AM, Pavão OF, Nogueira-Martins LA, Bosi Ferraz M. Stressors in ICU: perception of the patient, relatives and health care team. Intensive Care Medicine. 1999; 25: 1421-1426.

[3] Gillis J, Lai C, Lin M, Lee S. Connecting palliative care and intensive care in Taiwan. International Journal of Gerontology. 2008; 2: 33-34.

[4] Lee SY, Hung CL, Lee JH, Shih SC, Weng YL, Chang WH, et al. Attaining good end-of-life care in intensive care units in Taiwan dilemma and the strategy. International Journal of Gerontology. 2009; 3: 26-30.

[5] Karamchandani K, Carr ZJ, Bonavia A, Tung A. Critical care pain management in patients affected by the opioid epidemic: a review. Annals of the American Thoracic Society. 2018; 15: 1016-1023.

[6] Cheng CW, Weng YM, Lin CC, Kuo CI, Lin CC. The effects of post-intubation hypertension in severe traumatic brain injury. Signa Vitae. 2013; 8: 24-29.

[7] McHardy FE, Chung F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia. 1999; 54: 444-453.

[8] Biro P, Seifert B, Pasch T. Complaints of sore throat after tracheal intu-bation: a prospective evaluation. European Journal of Anaesthesiology. 2005; 22: 307-311.

[9] Kajal K, Dharmu D, Bhukkal I, Yaddanapudi S, Soni SL, Kumar M, et al. Comparison of three different methods of attenuating postoperative sore throat, cough, and hoarseness of voice in patients undergoing tracheal intubation. Anesthesia, Essays and Researches. 2019; 13: 572-576.

[10] Soltani HA, Aghadavoudi O. The effect of different lidocaine application methods on postoperative cough and sore throat. Journal of Clinical Anesthesia. 2002; 14: 15-18.

[11] Grap MJ, Blecha T, Munro C. A description of patients’ report of endotracheal tube discomfort. Intensive & Critical Care Nursing. 2002; 18: 244-249.

[12] Lin HC, Yen TA, Wu ET, Wang CC. Conservative management of a 13-year-old boy with postintubation tracheal injury. J Formos Med Assoc 2015; 114(1):90-91.

[13] Chandler M. Tracheal intubation and sore throat: a mechanical explanation. Anaesthesia 2002; 57: 155–161.

[14] Chao A, Chou WH, Huang HH, Yeh YC, Lin CJ. Evaluation of tracheal intubation: A retrospective study of skill acquisition by medical students in the operating theater. Journal of the Formosan Medical Association. 2015; 114: 855-859.

[15] Shinn JR, Kimura KS, Campbell BR, Sun Lowery A, Wootten CT, Garrett CG, et al. Incidence and outcomes of acute laryngeal injury after prolonged mechanical ventilation. Critical Care Medicine. 2019; 47: 1699-1706.

[16] Rotondi AJ, Chelluri L, Sirio C, Mendelsohn A, Schulz R, Belle S, et al. Patients’ recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Critical Care Medicine. 2002; 30: 746-752.

[17] Lee S, Wu C, Kuo L, Lai C, Hsu C, Hwung H, et al. The effects of xylocaine spray for pain control caused by endotracheal tube in critical care. International Journal of Gerontology. 2012; 6: 11-15.

[18] Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Critical Care Medicine. 2002; 30: 119-141.

[19] Mallick A, Smith SN, Bodenham AR. Local anaesthesia to the airway reduces sedation requirements in patients undergoing artificial ventilation. British Journal of Anaesthesia. 1996; 77: 731-734.

[20] Forrest JA, Finlayson ND, Adjepon-Yamoah KK, Prescott LF. An-tipyrine, paracetamol, and lignocaine elimination in chronic liver disease. British Medical Journal. 1977; 1: 1384-1387.

[21] Kotaki H, Tayama N, Ito K, Mitomi N, Tezuka K, Kaga K, et al. Safe and effective topical application dose of lidocaine for surgery with laryngomicroscopy. Clinical Pharmacology and Therapeutics. 1996; 60: 229- 235.

[22] Fruncillo RJ, Gibbons W, Bowman SM. CNS toxicity after ingestion of topical lidocaine. The New England Journal of Medicine. 1982; 306: 426-427.

[23] Curley RK, Baxter PW, Tyldesley WR. An unusual cutaneous reaction to lignocaine. British Dental Journal. 1987; 162: 113-114.

[24] DeToledo JC. Lidocaine and seizures. Therapeutic Drug Monitoring. 2000; 22: 320-322.

[25] Rincon E, Baker RL, Iglesias AJ, Duarte A. CNS toxicity after topical application of EMLA cream on a toddler with molluscum contagiosum. Pediatric Emergency Care. 2000; 16: 252-254.

[26] Merskey H. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl. 1986; 3: S1-S226.

[27] Drendel AL, Kelly BT, Ali S. Pain assessment for children: overcoming challenges and optimizing care. Pediatric Emergency Care. 2011; 27: 773- 781.

[28] Simon, Gielen, Vree, Booij. Disposition of lignocaine for intravenous regional anaesthesia during day-case surgery. European Journal of Anaesthesiology. 1998; 15: 32-37.

[29] Hung N, Wu C, Chan S, Lu C, Huang Y, Yeh C, et al. Effect on postoperative sore throat of spraying the endotracheal tube cuff with benzydamine hydrochloride, 10% lidocaine, and 2% lidocaine. Anesthesia and Analgesia. 2010; 111: 882-886.

[30] Pantuck AJ, Goldsmith JW, Kuriyan JB, Weiss RE. Seizures after ureteral stone manipulation with lidocaine. The Journal of Urology. 1997; 157: 2248.

[31] MICROMEDEX. Lidocaine. THOMSON. 2021. Available at: https: //www-micromedexsolutions-com.autorpa.mmh.org.tw/micromedex2/librarian/PFDefaultActionId/evidencexpert. DoIntegratedSearch?navitem=topHome&isToolPage=true#

(Accessed: 20 December 2020).

[32] Godfrey B, Parten C, Buckner EB. Identification of special care needs: the comparison of the cardiothoracic intensive care unit patient and nurse. Dimensions of Critical Care Nursing. 2006; 25: 275-282.

[33] Cochran J, Ganong LH. A comparison of nurses’ and patients’ perceptions of intensive care unit stressors. Journal of Advanced Nursing. 1989; 14: 1038-1043.

[34] Soh KL, Soh KG, Ahmad Z, Abdul Raman R, Japar S. Perception of intensive care unit stressors in Malaysian Federal Territory hospitals. Contemporary Nurse. 2008; 31: 86-93.

[35] Samuelson KAM. Adult intensive care patients’ perception of endotra-cheal tube-related discomforts: a prospective evaluation. Heart & Lung. 2011; 40: 49-55.

[36] Sharma CV, Mehta V. Paracetamol: mechanisms and updates. Continuing Education in Anaesthesia Critical Care & Pain. 2013; 14: 153-158.

[37] MICROMEDEX. Acetaminophen. THOMSON. 2021. Available at: https://www-micromedexsolutions-com.autorpa. mmh.org.tw/micromedex2/librarian/PFDefaultActionId/evidencexpert.DoIntegratedSearch?navitem=topHome& isToolPage=true#close (Accessed: 20 December 2020).

[38] Botting R, Ayoub SS. COX-3 and the mechanism of action of paracetamol/acetaminophen. Prostaglandins, Leukotrienes, and Essential Fatty Acids. 2005; 72: 85-87.

[39] Shimodaira T, Mikoshiba S, Taguchi T. Nonsteroidal anti-inflammatory drugs and acetaminophen ameliorate muscular mechanical hyperalgesia developed after lengthening contractions via cyclooxygenase-2 indepen-dent mechanisms in rats. PLoS ONE. 2019; 14: e0224809.

[40] Kogler VM, Deutsch J, Sakan S. Analgesia and sedation in hemodynamic unstable patient. Signa Vitae. 2008; 3: S10-S12.

[41] Mekhemar NA, El-Agwany AS, Radi WK, El-Hady SM. Comparative study between benzydamine hydrochloride gel, lidocaine 5% gel and lidocaine 10% spray on endotracheal tube cuff as regards postoperative sore throat. Brazilian Journal of Anesthesiology. 2016; 66: 242-248.

[42] Fagan C, Frizelle HP, Laffey J, Hannon V, Carey M. The effects of intracuff lidocaine on endotracheal-tube-induced emergence phenomena after general anesthesia. Anesthesia and Analgesia. 2000; 91: 201-205.

[43] D’Aragon F, Beaudet N, Gagnon V, Martin R, Sansoucy Y. The effects of lidocaine spray and intracuff alkalinized lidocaine on the occurrence of cough at extubation: a double-blind randomized controlled trial. Canadian Journal of Anaesthesia. 2013; 60: 370-376.

[44] Grinde B. Orofacial pain conditions-pain and oral mucosa. Tandlæge-bladet. 2016; 120: 100-107. (In Danish)