The Effect of Local Anesthetic on Quality of Recovery Characteristics Following Dental Rehabilitation Under General Anesthesia in Children

Abstract

This study is a randomized, prospective, double-blind study to evaluate the effects of the combination of local anesthetics and an intravenous nonsteroidal anti-inflammatory drug ( NSAID) vs NSAID alone on quality of recovery following dental rehabilitation under general anesthesia (GA ). Twenty-seven healthy children aged 3^5.5 years underwent dental rehabilitation under GA. Fifteen children in the experimental group received oral infiltration of local anesthetic in addition to intravenous ketorolac tromethamine, while 12 children in the control group received intravenous ketorolac tromethamine alone for postoperative pain management. Pain behaviors were evaluated immediately postoperatively using a FLACC scale and 4 hours postoperatively by self-report using various scales. Parents reported perception of child pain and comfort and any occurrences of postoperative cheek biting. The use of intraoral infiltration local anesthesia for complete dental rehabilitation under general anesthesia for children aged 3^5.5 years did not result in improved pain behaviors in the postanesthesia care unit (PACU), nor did it result in improved pain behaviors 4^6 hours postoperatively as measured by the FLACC scale, FACES scale, and subjective reports of parents or a PACU nurse. Those children receiving local anesthesia had a higher incidence of negative symptoms related to local anesthetic administration, including a higher incidence of lip and cheek biting, which was of clinical importance, but not statistically significant. Infiltration of local anesthetic for dental rehabilitation under general anesthesia did not improve quality of recovery in children aged 3^5.5 years.

Postoperative Pain in Children After Dentistry Under General Anesthesia

“…1,[44][45][46] Seventy percent of the cases received 2% lidocaine with 1 : 100,000 epinephrine given by infiltration with an anticipated duration of action in soft tissue of approximately 3 hours. The analysis performed used the highest FPS-R score within the first 12 hours after discharge overcoming the local anesthetic effect.…”

“…1 It is a concrete experience and an abstract concept. 2 Pain results from actual or potential tissue damage, but the perception of pain is modified by physiological mechanisms in the complex human nervous system.…”

“…Our literature review identified 6 publications that studied morbidity following pediatric dental rehabilitation under GA 1,9,13,[15][16][17][18][19][20][21][22][23] and 4 studies that focused on postoperative pain as their primary outcome. 15,19,22,23 While collective interpretation of these previous studies was difficult with the variability in age, demographics, and implemented pain assessment tools, postoperative pain remained the most common and long-lasting morbidity after pediatric dental rehabilitation.…”

Complaints of Paediatric Patients After Dental Treatment Under General Anaesthesia I: Pain. A Prospective Observational Study.

“…Local anaesthesia (LA) during DTGA is frequently used for surgical procedures to decrease postoperative pain. Lidocaine is one of the most widely used pharmacological agents for LA in the dental practice [17,18]. The use of LA during DTGA is a rather controversial topic.…”

“…The use of LA during DTGA is a rather controversial topic. Numbness caused by LA may increase the occurrence of cheek, lip or tongue biting resulting in painful traumatic ulceration [16,18,19], on the other hand it may reduce postoperative pain [16].…”