Effect of Preoperative Budesonide on Postoperative Sore Throat: A Systematic Review and Meta-Analysis

Abstract

Background: Postoperative sore throat (POST) is a common complication following endotracheal intubation. Various pharmacological interventions have been explored for POST prevention, with budesonide emerging as a promising option due to its anti-inflammatory properties. Methods: PubMed, Scopus, Web of Science and the Cochrane Library were searched following PRISMA guidelines. The primary outcomes were POST incidence and severity. Incidence data were pooled using random- or fixed-effects models. Severity analysis focused on budesonide versus saline studies, applying an ordinal logistic regression (mild, moderate, severe) with group assignment as the predictor, and predicted probabilities were computed in R. Results: Budesonide significantly reduced the incidence of POST compared to placebo (OR 0.28, 95% CI: 0.18-0.41, P < .001, I² = 52%) and no intervention (OR 0.09, 95% CI: 0.05-0.14, P < .001, I² = 0%). It demonstrated similar efficacy to magnesium sulfate and ketamine (P > .05). Budesonide also reduced POST severity, increasing the likelihood of mild symptoms while decreasing moderate and severe cases (OR 0.46, 95% CI: 0.26-0.81). Additionally, budesonide combined with dexamethasone was more effective than budesonide alone in reducing POST incidence and severity. Conclusion: Preoperative budesonide is an effective prophylactic agent for reducing the incidence and severity of POST. Its localized anti-inflammatory action, cost-effectiveness, and minimal systemic side effects make it a viable option for clinical use. However, variations in dosing and administration require further high quality RCTs to establish standardized guidelines.