Post-operative pain and pain management in children after dental extraction under general anaesthesia

Abstract

To evaluate post-operative pain in children and compare self-ratings of pain with those of a parent, and to study analgesic use after dental extractions under general anaesthesia (GA). Prospective observational study. One hundred children, aged 3-12 years, who had extractions performed under GA participated. After treatment, the child and one parent assessed post-operative pain on 5 occasions: before discharge, the evening of the treatment day, and the following three evenings. The parent rated the child's level of pain on a visual analogue scale (VAS), and the child made two ratings, one on a facial analogue scale (FAS) and one on a coloured analogue scale (CAS). Analgesics were recommended 3-4 times daily, and the parent recorded the intake. Seventy-eight children only had primary teeth extracted, 8 children had both primary and permanent teeth extracted, and 14 children only had permanent teeth extracted. The median number of extracted primary teeth was 5 (range 1-12) and of permanent teeth 3 (range 1-4). The median pain ratings were highest in the post-operative ward, VAS=1.0 (max 9.2), FAS=2 (max 10), and CAS=1.4 (max 10). The second highest median values were in the evening following treatment. No significant differences were found between pain ratings of the parent and the child or between the two ratings of the child. 60% took analgesics on day 1. On day 2, 45% took analgesics, of which 29% more than once. Spearman's rank correlation coefficient was used to test concordance between ratings. Most children had mild or no pain, and parent and child pain ratings agreed well. The dentist's analgesic recommendations were often poorly followed.