Effect of 5% EMLA Cream on Postoperative Sore Throat in Adults Following General Endotracheal Anesthesia: A Randomized Placebo-Controlled Study

Murugaiyan, A; Sahoo, AK; Rao, PB; Misra, S

doi:10.1213/ane.0000000000006269

Perioperative medicine & outcomes

Effect of 5% Eutectic Mixture of Local Anesthetics (EMLA) Cream on Postoperative Sore Throat in Adults Following General Endotracheal Anesthesia: A Randomized Placebo-Controlled Study

Anesth AnalgPublished 1 Nov 2022Randomised controlled trial

Primary resultResultRelative risk 0.12 95% CI 0.05–0.29

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Authors' conclusion

The application of EMLA cream over ETT cuff reduces the incidence and severity of POST, cough, and hoarseness of voice in adults after general anesthesia in the early postoperative period compared to lubricant gel.

Study context

Population: Adults 18 to 65 years, American Society of Anesthesiologists (ASA) I and II, either sex, under general endotracheal anesthesiacompleted the study
Participants: 204 adults

Comparison: 5% EMLA cream vs lubricant gel applied over the endotracheal tube (ETT) cuff
Primary endpoint: Incidence of POST
Follow-up: Sixth postoperative hour

Methodological detailsplacebo-controlled

Placebo-controlled

Primary result

As reported in the abstract

Relative risk

0.12

95% CI 0.05–0.29

P < 0.001

By group

EMLA4.9%

Placebo40.1%

EMLA vs Placebo

RR 0.12 (95% CI 0.05–0.29); P < 0.001

NNT to prevent postoperative sore throat (POST): 3

Secondary outcomes

Outcome	EMLA	Placebo	← Lower risk with EMLA ←→ Higher risk with EMLA →	RR (95% CI)	P value
Incidence of POST · 0 hour	74.5%	93.1%	0.050.21520	0.8 (0.7–0.9)	P < 0.001
Incidence of POST · second hour	51.9%	84.3%	0.050.21520	0.61 (0.5–0.75)	P < 0.001
Incidence of POST · 24 hours	1.9%	3.9%	0.050.21520	0.5 (0.09–2.67)	P = 0.4
			0.050.21520Relative risk (log scale)

Significant POST (score ≥2) · over 24 hours

P < 0.001

EMLA9.8%

Placebo43.1%

Severe cough · over 24 hours

P < 0.001

EMLA8.8%

Placebo31.4%

Hoarseness of voice · over 24 hours

P < 0.001

EMLA2%

Placebo7.4%

Incidence of POST — NNT to prevent POST: 5
Incidence of POST — NNT to prevent POST: 3

Postoperative cough and hoarseness of voice

Significantly less at 0, second and sixth hours in the EMLA group, comparable at 24 hours

Original publication

Effect of 5% EMLA Cream on Postoperative Sore Throat in Adults Following General Endotracheal Anesthesia: A Randomized Placebo-Controlled Study. Anesth Analg. Published 1 November 2022. doi:10.1213/ane.0000000000006269

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