Assessment of early postoperative pain and haemorrhage in young children undergoing dental extractions under general anaesthesia

Background. There have been a lot of guidelines issued about dental extractions under general anaesthesia. There is a considerable body of research about the use of local anaesthetic as an adjunct. Some of this research appears to be contradictory about the use of local anaesthetic in addition to general anaesthesia in very young children. This study attempts to clarify the issue. Aim. To determine whether postoperative pain/distress in the early recovery period was different for those children who did or did not have local infiltration anaesthesia for extractions under general anaesthetic, and whether the incidence of clinically significant postoperative bleeding was different for the two groups. Design. Children aged 2-6 years, admitted for extraction of deciduous posterior teeth under general anaesthetic, were randomized to groups that were or were not given local infiltration anaesthesia during the procedure. The children were premedicated with paracetamol and ibuprofen, and had absorbable haemostatic packs inserted during the operation. Staff blinded to treatment allocation made observations in the recovery period of pain and any interventions for bleeding. Results. There was no difference in postoperative pain, as measured using CHEOPS scale between the two groups, but an increase in post operative bleeding in the group who did not have local anaesthetic administered 5/38 compared to 0/38, P = 0.02. Conclusions. As use of local anaesthetic reduces bleeding without altering pain or distress in young children undergoing posterior deciduous tooth extraction, we should consider using as an adjunct to general anaesthesia.