The association between operation time and post-operative pain in endoscopic sinonasal surgery. Short title: Operative time and post-op pain after ESS


  • Yossawee Wangworawut Department of Otolaryngology–Head and Neck Surgery, Thammasat University, Pathumthani, Thailand
  • Peter H. Hwang Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA


Endoscopic sinus surgery, Endoscopic sinus surgery, Pain, Pain, Post-operative pain, Post-operative pain, Operation time, Operation time, Association, Association, And opioid usage, And opioid usage


Background: United States is now in the midst of opioid crisis. To reduced perioperative opioid usage, is mean to reduce post-operative pain. This study try to find the association between operative time and post-operative pain in patient who received endoscopic sinonasal surgery. We also aim to study other factors that may play a role in post-operative pain.

Method: We performed a retrospective review of 624 patients, who have sinonasal disease and received endoscopic surgery from the same surgeon, in a tertiary care rhinology clinic from 2015 – 2018. Demographic data, diagnosis, duration of disease, Lund-Mackay CT score, operation, operation time, having bone drill, blood lost, time in PACU, and length of hospital stay were reviewed.
For pain measurement we use patient self-reported visual analog scale from one to ten. Post-operative pain scale, intra-operative and post-operative analgesic usage were reviewed.

Result: One minute increasing in operation time will increase post-operative pain scale by 0.002 point (P = 0.037). When matched by same operation type, operation time still shows positive correlate with post-operative pain scale but lost its significant. Factors which positively associated with higher post-operative pain including: African American race; female; younger age (≤45 year old); and high BMI (all are P < 0.05). Increasing in duration of disease by ten months will decrease post-operative pain scale by 0.05 point (P = 0.011).

Conclusion: Operative time is associated with post-operative pain in endoscopic sinonasal surgery. The shorter the operation time, the less post-operative pain. Multiple factors both biological and psychological play a role in characterized individual pain experiences.






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