Analgesia in Transcutaneous Laryngeal Botulinum Toxin Injections: A Randomized Crossover Trial

• Published in: The Laryngoscope 2024-05, Vol.134 (5), p.2277-2281
• Main Authors: Heyes, Richard, Adler, Charles H., Yee, Claire, Lott, David G., Karle, William E.
• Format: Article
• Language: English
• Subjects: analgesia; Analgesics; Anesthesia; Botulinum toxin; laryngeal dystonia; Patients; spasmodic dysphonia; vocal tremor
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.31208

Objectives There is an absence of data in the literature regarding methods to improve the patient experience during the performance of awake in‐office laryngeal injections. This study sought to evaluate whether the use of local anesthetic or a vibrating instrument decreased overall pain experienced by patients with laryngeal dystonia, frequently referred to as spasmodic dysphonia (SD), undergoing transcervical botulinum toxin injections. Methods This was an unblinded, prospective randomized control trial with a crossover design where each patient received transcutaneous transcricothyroid injection of botulinum toxin with alternating use of no anesthesia, local anesthesia (2% lidocaine in 1:100,000 epinephrine), and vibrating instrument in three consecutive laryngeal injections to treat adductor SD. Patients were randomized to the order they received these treatments. Patients measured pain on a 0–10 visual analogue scale (VAS) and selected their preferred technique after receiving all three analgesic modalities. Results Thirty‐two patients completed the study. There was no statistically significant difference in pain between the three analgesic techniques (p = 0.38). The most preferred analgesic technique was the vibrating wand (44% (14/32)). Lidocaine was the second most preferred (37% (12/32)) and 19% (6/32) of patients preferred nothing. When combining the wand and nothing groups, 63% of patients preferred one of these two methods (95% exact CI: 44%–79%). Conclusion There was no statistically significant difference in median pain experienced by patients during laryngeal botulinum toxin injection between these different analgesic modalities. More than half of the patients selected a preference for a technique that did not include lidocaine. This data supports individualization of analgesia during transcutaneous laryngeal injections. Level of Evidence 2 Laryngoscope, 134:2277–2281, 2024 This is a study of 32 patients with adductor spasmodic dysphonia who underwent transcutaneous laryngeal botulinum toxin injection. All participants received injection without anesthesia, with lidocaine, and with the use of a vibrating instrument. Patients were randomized to the order of receiving these treatments. Nearly two‐thirds of patient's preferred injection without lidocaine. There was no difference in pain between analgesic techniques.