Perioperative local anaesthetic in young paediatric patients undergoing extractions under outpatient 'short-case' general anaesthesia. A double-blind randomised controlled trial

• Published in: British dental journal Vol. 203; no. 6; p. E11
• Main Authors: Leong, K. J, Roberts, G. J, Ashley, P. F
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 22-09-2007
• Subjects: Administration, Rectal; Airway management; Analgesics; Analgesics - administration & dosage; Analysis of Variance; Anesthesia Recovery Period; Anesthesia, Dental - methods; Anesthesia, General - methods; Anesthesia, Local; Anesthetics, Local - administration & dosage; Anxiety; Child; Child, Preschool; Children & youth; Dental Anxiety - prevention & control; Dental Care for Children - methods; Dentistry; Double-Blind Method; General anesthesia; Humans; Nonsteroidal anti-inflammatory drugs; Pain; Pain Measurement; Pain, Postoperative - prevention & control; Pediatrics; Periodontal Ligament; Perioperative Care - methods; R&D; Research & development; Statistics, Nonparametric; Teeth; Tooth Extraction
• ISSN: 0007-0610; 1476-5373
• DOI: 10.1038/bdj.2007.724

To investigate if postoperative pain/discomfort and anxiety experienced by young children who had extractions under general anaesthesia (GA) were affected by perioperative injection techniques of local anaesthetic (LA).
A single-centre, double-blind, randomised controlled trial.
Conducted in 2002/2003 at the Unit of Paediatric Dentistry, Eastman Dental Hospital, London.
Children, aged 2-6 years scheduled for extractions under GA, were randomly assigned to receive either no LA (NLA), infiltration injection (IFL) or intraligamental injection (ITR) perioperatively. All children received analgesic suppositories after induction.
Anxiety was scored using the Venham Picture Scale. Postoperative pain was scored using the Simplified Toddler-Preschooler Postoperative Pain Scale and supplemented with the Modified Pain/Discomfort Scale.
Eighteen children received NLA, 17 received IFL and 19 received ITR. Postoperative pain/discomfort and anxiety scores were not significantly different during the period of recovery. On the first night, the intraligamental group had significantly lower pain scores (p = 0.012).
Postoperative pain/discomfort and anxiety during the period of recovery experienced by young children who had extractions under GA appear not to be affected by perioperative injection techniques of LA. Upon discharge, intraligamental injection appears beneficial, as it is probably well tolerated by causing less soft tissue numbness initially and thus, reduces perceived pain/discomfort.