Pain Experience and Tolerance of Awake In-Office Upper Airway Procedures: Influencing Factors

Objectives/Hypothesis: Awake, unsedated in-office upper airway procedures are performed frequently and have high completion rates, yet less is known about the patients' pain experience and potentially influencing factors. It is also unclear if patients' pain experiences become worse with repeated procedures. We identified procedure- and patient-related factors that might influence procedural completion and pain scores. Study Design: Retrospective chart review. Methods: Pre-, intra-, and post-procedure pain scores were collected prospectively for awake unsedated upper airway procedures performed at a single institution over a 5-year period. Patient factors reviewed were demographics, body mass index, psychiatric and/or pain diagnosis, and related medications. Procedure factors reviewed were procedure type, route, side, and performance of the same procedure multiple times. Patients reported their pain level before, during, and after the procedure using a standard 0 to 10 scale. Maximum pain score change (P Delta max), or the difference between highest and lowest reported pain levels, was calculated. Descriptive and multivariate analyses were performed. Results: Procedure completion was 98.7% for 609 first time patients and 99.0% in 60 patients undergoing 292 repeat procedures. P Delta max did not covary with age, gender, or BMI. P Delta max covaried with pain and psychiatric conditions and associated medications. P Delta max was highest for injection medialization and lowest for tracheoscopy. P Delta max decreased over time for those undergoing multiple identical procedures. Conclusions: Procedures were performed with a very high completion rate and low pain scores. Age, sex, and BMI did not affect pain experience. A combination of pain and psychiatric conditions did. Injection medialization had the highest P Delta max and tracheoscopy the lowest.