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

Key Points During the period of recovery, postoperative anxiety and pain experienced by young children who had extractions under general anaesthesia with preoperative analgesic suppositories were not affected by perioperative injection techniques of local anaesthesia. Perioperative intraligamental injection of local anaesthetic appears beneficial as it results in lower postoperative pain scores on the first night postoperatively. The use of preoperative analgesic suppository with perioperative local anaesthetic remains beneficial as postoperative pain control for extractions under general anaesthesia. Objective 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). Design A single-centre, double-blind, randomised controlled trial. Setting Conducted in 2002/2003 at the Unit of Paediatric Dentistry, Eastman Dental Hospital, London. Methods 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. Outcome measures 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. Results 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). Conclusion 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.