Intra-operative local anaesthesia to reduce postoperative pain or distress in children after exodontia under general anaesthesia

Abstract

A randomised controlled trial (RCT). The appropriate drugs and dosage, namely 2 ml of 2% lidocaine with 1:200 000 epinephrine (adrenaline), or placebo of 2 ml of 0.9% sodium chloride, were administered by buccal infiltration injection adjacent to the teeth to be removed, after induction of general anaesthesia (GA). Pain scores were recorded pre-operatively and after treatment upon waking, after 30 min and after 24 h; distress scores were recorded pre-operatively, upon waking and after 30 min following treatment. Lip and cheek biting injuries were also recorded. One hundred and forty-two children were recruited to the study and randomly allocated to one of the two groups. Data were incomplete for three children. There were no statistically significant differences between the mean pain scores for the local anaesthetic and placebo group pre-operatively, on waking from the GA, at 30 min postoperatively or after 24 h. There were statistically significant increases in pain in both groups from pre-operative levels, with 13% of treatment and 12% of control patients recording severe pain and 13% of treatment and 10% of control patients recording very severe pain. These rates were similar at 30 min but reduced at 24 h following treatment. Lip or cheek biting injuries occurred in one control and three treatment patients. Intra-operative local anaesthesia has been found to be effective for pain control following a range of other surgical procedures, but we did not find it to be effective in reducing postoperative pain or distress in children after oral surgery.