Use of Local Anesthesia During Dental Rehabilitation With General Anesthesia: A Survey of Dentist Anesthesiologists

Abstract

The purpose of this study was to document current practices of dentist anesthesiologists who are members of the American Society of Dentist Anesthesiologists regarding the supplemental use of local anesthesia for children undergoing dental rehabilitation under general anesthesia. A survey was administered via e-mail to the membership of the American Society of Dentist Anesthesiologists to document the use of local anesthetic during dental rehabilitations under general anesthesia and the rationale for its use. Seventy-seven (42.1%) of the 183 members responded to this survey. The majority of dentist anesthesiologists prefer use of local anesthetic during general anesthesia for dental rehabilitation almost always or sometimes (90%, 63/70) and 40% (28/70) prefer its use with rare exception. For dentist anesthesiologists who prefer the administration of local anesthesia almost always, they listed the following factors as very important: "stabilization of vital signs/decreased depth of general anesthesia" (92.9%, 26/28) and "improved patient recovery" (82.1%, 23/28). There was a significant association between the type of practice and who determines whether or not local anesthesia is administered during cases. The majority of respondents favor the use of local anesthesia during dental rehabilitation under general anesthesia.

Office-Based Anesthesia: Safety and Outcomes in Pediatric Dental Patients

“…Conversely, Al-Bahlani et al 33 reported an increase in postoperative distress in children recovering from general anesthesia who received infiltration with local anesthetic. In a survey of American Academy of Pediatric Dentistry members, Townsend et al 34 reported there is no consensus among members on the use of local anesthesia during dental rehabilitation under general anesthesia. In a separate study, Townsend et al 35 surveyed dentist anesthesiologists and 90.0% reported they preferred administration of local anesthesia, citing benefits including stabilization of vital signs/ decreased depth of general anesthesia and improved patient recovery.…”

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

“…In our study we found that the administration of LA before extractions did not affect postoperative pain, however, local numbness might be unpleasant. Those who oppose the use of LA report self-in icted soft tissue trauma (morsication of the lips, cheeks, or tongue) due to loss of sensation [16,35]. We did not observe any of these injuries during follow-up appointments.…”

“…Various studies support the use of LA as supplementary medication to reduce postoperative pain [16,24,32,33]. Nevertheless, the use is still controversial.…”

“…Pain management is a pivotal point in paediatric dentistry. Systemic analgesics could be used to reduce pain intra-and postoperatively [16]. Opioids, non-steroidal anti-in ammatory drugs (NSAIDs) and acetaminophen are commonly administered systemic analgesics.…”

“…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].…”