Pain and analgesia requirement after day case exodontia in children

Abstract

Introduction Children undergoing day case dental extractions are not routinely given systemic analgesia and it is sometimes debated if such patients should receive i.v. opioids or NSAIDs intraoperatively. Infiltration with local anaesthesia during GA has been shown to reduce early postoperative distress after exodontia in children, and the severity of distress is related to the number of teeth extracted (1). We have conducted an audit to assess the severity of pain and the analgesic requirements of children undergoing dental extraction under the care of the community dental service in a day ward setting of a teaching hospital.Methods After preoperative assessment, children were accompanied to theatre by a parent, and anaesthesia was induced either with intravenous propofol or by inhalation of sevoflurane in nitrous oxide and oxygen, followed by maintenance with the same. Children breathed spontaneously via a Humphrey ADE system with a FGF of 3 l·min−1 delivered by a facemask +/– a nasal airway or a LMA. Apical infiltration of prilocaine 3% with felypressin 0.03 unit·ml−1 was used for extraction of most deciduous ‘D’, ‘E’ teeth or for permanent ‘6’ teeth. After surgery, the patient was transferred to a recovery area adjacent to the operating room.Age, weight, ASA score, number and type of teeth extracted and use of local anaesthetic were noted in the operating room. Recovery nurses recorded pain severity on awakening and on discharge. Analgesia given in recovery (if any) was also noted. On discharge, parents were given a questionnaire to complete and return by post. Details requested in the questionnaire were the amount and frequency of analgesia required on the day of the dental extraction, pain severity, presence of night pain and the severity of pain the next morning.Results Eighty‐seven children between the age of 2 and 11 participated in the audit. Except for one child who was ASA 3, all the others were either ASA 1 or 2. The average weight of the children was 22 kg and average number of teeth extracted per child was 6 (range 1–14). Local infiltration was given to 56 out of 87 children.The majority of the children had no pain or only mild pain (88%) and required or received no analgesia in recovery. Eleven children (12%) who needed paracetamol in recovery had either ‘D’, ‘E’ or ‘6’ removed and had pain scores recorded as moderate or severe. Eight of these 11 children did not have local anaesthetic infiltration. (Fig. 1).Pain scores of children on waking up from anaesthetic and before discharge from the hospital.imageReturn rate of questionnaires was 57%. The majority of the children (72%) required paracetamol on the day of the extraction at home irrespective of the number and type of teeth extracted and had mild or no pain. Extraction of ‘D’, ‘E’ or ‘6’ was associated with higher pain scores up to 24 hrs post‐extraction.Conclusions Pain is very subjective and can be difficult to assess in children. Our audit showed that after simple extruction of deciduous teeth, children do not routinely need analgesia in the hospital. However, if ‘D’, ‘E’ or ‘6’ is extracted, it is important to ensure that proper analgesia is given and this may pretrentially be infiltration with prilocaine.