In both procedures, adequate local anesthesia is necessary in awake patients.

Dear Sir, Both the procedures value of pain is only felt at post operative condition and the surgical pain is to be valued at WHAT type of surgery and the intubation procedure pain is more or less same in all patients which sustain for couple of days. Thanks

When we discuss about the intensity of pain produced by the intubation procedure. We explain to students that intubation is as pain as surgical incision so patient need good depth of anesthesia and analgesia to attenuate the pain of intubation. As regard to which out of two is more pain depend upon anesthesiologist and surgeon involved in intubation and surgical incision. Smooth and rapid intubation will definitely be less painful. Same stand for surgical incision gentle tissue handling causes less pain. Both are noxious stimulus, therefore, patient should given good amount  of analgesia and depth   of anesthesia to attenuate their physiological response.

Dear sir,

As per what has been taught to us and continued so far, Intubation response is supposed to produce maximal response and requires good depth of anesthesia. This also depends on multiple factors like drugs given prior, comorbid conditions of the patient, duration of laryngoscopy, technique and equipment used. The next surge of responses begin at the time of incision if regional anesthesia is not administered at the site of incision or the area is not adequately blocked. These are explained beautifully by the peaks and plateaus during the intraoperative period in the textbook of Anesthesia by Ronald Miller. But there are no specifications as which is higher as both of them go together.

With adequate local anesthesia, neither is painful, but I don't think that is the question. When I look at my data for propofol-remifentanil isoboles required to obtund response to stimulus, nothing comes close to touching the carina without local. Vocal cords second. Most other things are way down in required depth of anesthesia.

Though both intubation and incision are maximal stimuli, they differ in nature. Surgical incision causes somatic pain and needs adequate analgesia for suppression. Intubation on the other hand causes somatic and stronger visceral stimulation and autonomic response needs to be suppressed by adequate anaesthesia. The pain sensation per se in expert hands is expected to be lesser in intubation.

With post intubation the throat is a little sore and irritated and with anesthesia for an incision is very uncomfortable and stings but once the area is numbed properly you only feel tugging which is kind of weird.  This I know from my own personal experience.

Both intubation and surgical incisions are invasive procedures that cause and produce known adverse physiologic responses. That is why appropriate sedation during endotracheal intubation and surgical procedures is highly recommended. 

Dear Colleagues! I think that we can find the answer in Miller's Anaesthesiology in chapter dedicated to the depth of anaesthesia. They consider that intubatiom more painful (more strong stimulus) in compare to icision. But they don't  explore postoperative pain.

I am not sure about the value of this question. Patient safety is supreme. Intubation takes place when the patient is most vulnerable to a possibly life ending event. Therefore, preserving ventilation is more important than worrying about pain. One has to accept an occasional unpleasant noxious stimulus, although avoiding it when it can be done safely, is preferable.

Intubation is as painfull as incision. And intubation accompanied by stronger autonomic nerver sistem irritation.

Anesthesia should be depth.

Dear doctor H.A Tillmann Hein,

Probably you didn't understand my question, in any elective surgery, intubation is more painful than surgical incision or not?

Referring to Depth of anesthesia, MAC is always referred to standardize stimulus which is surgical incision!

Thank you all for answering my question

I believe more  painfull intubation.

difficult to answer

I don't think 'painful' is the correct word. They're also not directly comparable because much as they both trigger a significant sympathetic response they do it via different mechanisms.

This paper might provide some information

https://www.ncbi.nlm.nih.gov/pubmed/31432382