A randomized prospective study comparing intracuff dexmedetomidine and alkalinized lidocaine for the prevention of postoperative sore throat, hoarseness, and cough in prolonged prone-position spine surgery

Background: Tracheal intubation is essential for securing the airway during general anesthesia but often results in postoperative sore throat (POST), hoarseness, and coughing, with reported incidences reaching ~65%, ~55%, and ~96%, respectively. These complications arise mainly from irritation, inflammation, and mechanical trauma caused by the endotracheal tube, particularly during prone-position procedures. Their severity depends on factors such as tube size, cuff pressure, and intubation duration. Preventive approaches include optimizing cuff pressure and using anti-inflammatory or local anesthetic agents. This study evaluated whether intracuff dexmedetomidine offers an advantage over alkalinized lidocaine in reducing POST during prolonged prone-position surgeries. Patients and Methods: In this prospective randomized study, 100 adult patients (aged 18-65 years, American Society of Anesthesiologists I-II) undergoing thoracolumbar spine surgery under general anesthesia between March and October 2025 were allocated to two groups: Group D received 4 mL of intracuff dexmedetomidine (4 µg/mL), and Group AL received 4 mL of 2% alkalinized lidocaine. Primary outcomes included the incidence and severity of POST, hoarseness, and pain assessed in the Post-Anesthesia Care Unit, and at 2 and 24 h postsurgery. Secondary outcomes included hemodynamic and procedural parameters. Results: Both groups were comparable in demographic and clinical variables. No statistically significant differences were found in POST incidence, hoarseness, pain scores, or hemodynamic measures, though dexmedetomidine showed a slight trend toward better symptom prevention. Conclusion: Intracuff dexmedetomidine provided a modest improvement over alkalinized lidocaine in reducing postextubation sore throat, hoarseness, and postoperative pain during prolonged prone-position spine surgery.