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CTRI Number  CTRI/2021/10/037492 [Registered on: 22/10/2021] Trial Registered Prospectively
Last Modified On: 29/10/2021
Post Graduate Thesis  No 
Type of Trial  Interventional 
Type of Study   Drug 
Study Design  Randomized, Parallel Group, Placebo Controlled Trial 
Public Title of Study   A clinical trial to study the effect of nebulized lignocaine and ketamine in reducing incidence of postoperative sore throat 
Scientific Title of Study   Comparison of the effects of nebulized Ketamine and nebulized Lignocaine in decreasing incidence of post-operative sore throat : A randomized control prospective study 
Trial Acronym  ketlo 
Secondary IDs if Any  
Secondary ID  Identifier 
NIL  NIL 
 
Details of Principal Investigator or overall Trial Coordinator (multi-center study)  
Name  Dr Deepali Valecha 
Designation  Assistant Professor 
Affiliation  Mahatma Gandhi Memorial Medical College, Indore 
Address  Department of Anaesthesiology, Maharaja Yeshwant Rao Hospital and Mahatma Gandhi Memorial Medical College

Indore
MADHYA PRADESH
452001
India 
Phone    
Fax    
Email  deepalisidhwani@gmail.com  
 
Details of Contact Person
Scientific Query
 
Name  Swapnil Kumar Barasker 
Designation  Assistant Professor 
Affiliation  Sri Aurobindo Medical College and PG Institute 
Address  Department of Anaesthesiology and Critical Care, Sri Aurobindo Medical College and PG Institute, Indore Ujjain State Highway, Near MR 10 Crossing

Indore
MADHYA PRADESH
453111
India 
Phone    
Fax    
Email  swapnilkbarasker@gmail.com  
 
Details of Contact Person
Public Query
 
Name  Swapnil Kumar Barasker 
Designation  Assistant Professor 
Affiliation  Sri Aurobindo Medical College and PG Institute 
Address  Department of Anaesthesiology and Critical Care, Sri Aurobindo Medical College and PG Institute, Indore Ujjain State Highway, Near MR 10 Crossing


MADHYA PRADESH
453111
India 
Phone    
Fax    
Email  swapnilkbarasker@gmail.com  
 
Source of Monetary or Material Support  
Department of Anaesthesiology, MGM Medical college and MY hospital Indore 
 
Primary Sponsor  
Name  Department of Anaesthesiology 
Address  MY hospital & MGM college Indore 
Type of Sponsor  Government medical college 
 
Details of Secondary Sponsor  
Name  Address 
NIL  NIL 
 
Countries of Recruitment     India  
Sites of Study  
No of Sites = 1  
Name of Principal Investigator  Name of Site  Site Address  Phone/Fax/Email 
Deepali Valecha  Ground floor OT Comlex, Department of Anaesthesiology, Maharaja Yeshwant Rao Hospital  MY hospital road, CRP line
Indore
MADHYA PRADESH 
9424405405

deepalisidhwani@gmail.com 
 
Details of Ethics Committee  
No of Ethics Committees= 1  
Name of Committee  Approval Status 
Ethics and scientific review Committe, MGM college and MY hospital Indore  Approved 
 
Regulatory Clearance Status from DCGI  
Status 
Not Applicable 
 
Health Condition / Problems Studied  
Health Type  Condition 
Patients  (1) ICD-10 Condition: O||Medical and Surgical,  
 
Intervention / Comparator Agent  
Type  Name  Details 
Intervention  ketamine 50 mg   Group K will recieve ketamine 50 mg (1.0 ml + 4.0 ml of the saline) nebulization 15 min prior to induction in pre op room.  
Intervention  lignocaine 4% nebulization  Group L will receive lignocaine 4% nebulization( 2ml lignocaine 4% + 3ml saline) 15 min prior to induction in pre op room.  
Comparator Agent  saline nebulization   Group C will recieve 5ml saline nebulization - 15 min prior to induction in pre op room. 
 
Inclusion Criteria  
Age From  18.00 Year(s)
Age To  60.00 Year(s)
Gender  Both 
Details  Patients with American Society of Anesthesiologists (ASA) class I or class II physical
status. 
 
ExclusionCriteria 
Details  1. Patient refusal ,
2. Pateints with ASA physical status III & IV,
3. History of allergic reactions to local anaesthetics or ketamine,
4. Patient with anticipated difficult intubation,
5. Duration of intubation more than 30s or more than 1 attempt of intubation,
6. Patients undergoing oral, head and neck surgeries,
7. Duration of surgery> 2hr 
 
Method of Generating Random Sequence   Coin toss, Lottery, toss of dice, shuffling cards etc 
Method of Concealment   Sequentially numbered, sealed, opaque envelopes 
Blinding/Masking   Participant, Investigator and Outcome Assessor Blinded 
Primary Outcome  
Outcome  TimePoints 
Incidence and severity of sore throat in first 24
hours of post operative period 
Sore throat monitoring and grading will be done
at 0,1, 2, 4, 8, 12, 16 and 24 hours post-extubation by
an anaesthetist not aware of the group of patients 
 
Secondary Outcome  
Outcome  TimePoints 
To report any complication or side effect due to nebulization of lignocaine and ketamine if seen  Monitoring will be done at 0, 2, 4, 8, 12, and 24
hours post-extubation by an anaesthetist. 
 
Target Sample Size   Total Sample Size="120"
Sample Size from India="120" 
Final Enrollment numbers achieved (Total)= "Applicable only for Completed/Terminated trials"
Final Enrollment numbers achieved (India)="Applicable only for Completed/Terminated trials" 
Phase of Trial   N/A 
Date of First Enrollment (India)   25/10/2021 
Date of Study Completion (India) Applicable only for Completed/Terminated trials 
Date of First Enrollment (Global)  Date Missing 
Date of Study Completion (Global) Applicable only for Completed/Terminated trials 
Estimated Duration of Trial   Years="0"
Months="6"
Days="0" 
Recruitment Status of Trial (Global)
Modification(s)  
Not Applicable 
Recruitment Status of Trial (India)  Open to Recruitment 
Publication Details   nil 
Individual Participant Data (IPD) Sharing Statement

Will individual participant data (IPD) be shared publicly (including data dictionaries)?  

Response - NO
Brief Summary   Introduction
Post-operative sore throat (POST) occurs in 21-65% of patients receiving general anaesthesia (GA) with tracheal intubation. (1,2) Post operative sore throat is an unavoidable complication of general anaesthesia. Localised trauma to the mucosa during laryngoscopy and intubation leads to aseptic inflammation of the pharyngeal mucosa leading to post-operative sore throat. It may lead to minor throat irritation, debilitating pain, inability to swallow and may even cause temporary voice changes.(3) Many non-pharmacological and pharmacological methods have been tried to reduce the incidence and severity of post-operative sore throat. Using a small sized endotracheal tube, gentle laryngoscopy and intubation, maintaining cuff pressures not more than 18-20cmH2O, and local anaesthetics, steroids, NSAIDs, benzydamine gargle, ketamine gargle are some of the methods used. Ketamine, a phencyclidine derivative, has been used as a gargle or nebulization in the attenuation of post-operative sore throat by its action on peripheral NMDA receptors.4,5,6. Nebulization of lignocaine can achieve highly effective anesthesia from the oral cavity up to trachea for intubation. Here in our study we want to compare the effects of nebulized ketamine and nebulized lignocaine in reducing incidence of post operative sorethroat in pateints undergoing Elective surgeries under general anaesthesia in supine position.
Methodology
The present study will be conducted after receiving approval by the Institutional Ethics Committee of our hospital and written informed consent will be taken from patients. Patients will be randomly allocated in three groups by chit method. Group K ( n=40), Group L ( n= 40) and Group C (n=40). The chits will be opened by the Anaesthesiologist who is not a part of study, and nebulisation solution will be prepared according to group allocation. Group L will receive lignocaine 4% nebulization( 2ml lignocaine 4% + 3ml saline) and Group K will receive ketamine 50 mg (1.0 ml + 4.0 ml of the saline) nebulization and Group C will receive 5ml saline nebulization - 15 min prior to induction in pre op room. Patients will be blinded to the study drug used. HR, MAP, SPO2 will be recorded during nebulization. A uniform anaesthetic technique will be used to induce General anaesthesia facilitating intubation using vecuronium as muscle relaxant in both the groups. The intra-operative monitoring will include continuous electrocardiography, noninvasive blood pressure, pulse oximetry , and end-tidal carbon dioxide. At the completion of
surgery, with the patient adequately anaesthetised, the oropharynx will be gently suctioned using gentle suction catheter. Extubation will be done after reversal on return of spontaneous ventilation. Patients will be assessed post operatively for sore throat using a four point scale.
POST was graded on a four-point scale (0-3) (7)
0 = no sore throat
1 = mild sore throat (complains of sore throat only on asking)
2 = moderate sore throat (complains of sore throat on his/her own)
3 = severe sore throat (change of voice or hoarseness, associated with throat pain).
Other side-effects, if any will be noted. IV tramadol 50mg 8hrly used for post operative pain.

SORE THROAT SCORE

 

SORE THROAT SCORE

0 HR

1 hr

2 HR

4 HR

8 HR

12 HR

16 HR

24 hr



GROUP K

 

 

 

 

 

 

 

 

 

 

GROUP L

 

 

 

 

 

 

 

 

 

 

GROUP C

 

 

 

 

 

 

 

 

 

 


References:
1. Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory
surgery. Br J Anaesth. 2002;88:582–4. [PubMed: 12066737]
2. Loeser EA, Bennett GM, Orr DL, Stanley TH. Reduction of postoperative sore
throat with new endotracheal tube cuffs. Anesthesiology. 1980;52:257–9.
[PubMed: 7369513]
3. Zuccherelli L. Post operative upper airway problems – Review article. SAAJA.
2003(9):12-6.
4. Patel MP, Patel HH, Roth DM. general anesthetics and therapeutic gases. In:
Goodman and Gilman’s The pharmacological basis of therapeutics. 12th edition.
Edited by Brunton LL, Chabner BA, Knollman BC 2011; chapter 19: 502-539
5. Stoelting RK, Hillier SC. Intravenous sedatives and hypnotics, In:
Pharmacology and Physiology in Anaesthetic Practice. 5th edition. Edited by
Stoelting RK, Hillier SC 2014; chapter 5: 186-93.
6. Vuyk J, Sitsen E, Reekers M. Intravenous anesthetics. In: Miller’s Anesthesia.
8th ed. Edited by Miller RD, Eriksson LI, Fleisher LA:Philadelphia, Elsevier.
2015, 845-848.
7. Canbay O, Celebi N, Sahin A, Celiker V , Ozgen S, Aypar U. Ketamine gargle
for attenuating postoperative sore throat. Br J Anaesth. 2008;100:490–3.
[PubMed: 18310675]
 
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