Intraligamental analgesia for post-operative pain control in children having dental extractions under general anaesthesia

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ABSTRACT

Aim

This was to assess the effectiveness and safety of intraligamental local analgesia (ILA) for postoperative pain control in
children having dental extractions under general anaesthesia (GA). The variables affecting the effectiveness of ILA were also
investigated.

Methods

Data were collected from children having permanent molars extracted under GA using a randomised half
mouth study design. ILA (bupivicaine 0.5 with 1:200,000 adrenaline) was used on the randomly assigned experimental side
prior to extraction of the teeth, and the contralateral control side received no ILA. Children were interviewed pre- and post-operatively by
the principal investigator (PA) who was blind to the side of ILA. Pre- and post-operative anxiety levels of each child were measured
using the Venham Picture Test (VPT). Patients were asked to rate which side was better in terms of pain control, whether they felt
numbness and whether they preferred the numbness. Their post-operative pain levels were also measured using the visual analogue
scale (VAS). Self-inflicted trauma following ILA was noted.

Results

Thirty children, with a mean age of 11.3 years (SD1.7)
completed the study. None of the patients had self-inflicted soft tissue trauma following ILA. Nineteen children (63) found that
pain control was better post-operatively on the side with ILA. Twenty-one children (70) reported numbness following ILA of
whom 14 (67) said that they preferred this. VAS scores were not significantly different between the experimental and control
sides. A higher percentage of boys (85) than girls (47) rated the ILA side "better" (p=0.034). VPT scores were
significantly higher for girls postoperatively (p=0.048).

Conclusion

ILA was a useful and safe adjunct for postoperative pain control
in children having permanent teeth extracted under GA. The technique was found to be more effective in boys than girls. However, less
than half the children in this study preferred the side with numbness. Further research is needed to determine effective methods of pain
control in children following dental GA and to investigate the reasons for gender differences of pain perception in children.

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