Cochrane · intervention · CD009742
Intraoperative local anaesthesia for reduction of postoperative pain following general anaesthesia for dental treatment in children and adolescents
Parekh, S, Gardener, C, Ashley, PF, et al. · Cochrane Database of Systematic Reviews · 2014 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
28
current version
GRADE rated
7
No studies
17
Included studies
14
as reported
No studies 17 · 60.7%Ungraded 4 · 14.3%Very low 7 · 25%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Participants aged 17 years or younger at the start of treatment having dental treatment including orthodontic treatment, fillings, removal of the nerve from a tooth, or extraction of a tooth under general anaesthesia | 1152 participants randomised across 14 studies; age range 2 to 40 years (eligibility 17 years or younger); dental care ranging from oral surgery/extractions to dental rehabilitation of primary teeth; conducted in the UK, Egypt, Saudi Arabia and the USA |
| Intervention | Any local anaesthetic (including type/dose/method) given during dental treatment under general anaesthesia | Infiltration injection LA (n=542 analysed); Intraligamental injection LA (n=115); Topical LA (n=343); Infiltration plus intraligamental injection LA, 3-arm study (n=54) |
| Comparison | Placebo or no local anaesthetic or another local anaesthetic (including type/dose/method) | No treatment; Placebo; Another local anaesthetic (infiltration versus intraligamental head-to-head) |
| Outcomes | Postoperative pain or distress measures (intensity, or presence or absence of pain); Intraoperative or postoperative bleeding; Cardiac arrhythmia, other cardiac or respiratory events, or both, and type and volume of general anaesthesia drug administered; Incidence of postoperative lip biting or cheek biting, prolonged numbness or allergy; Participant satisfaction; Parental satisfaction; Postoperative anxiety | Postoperative pain or distress (n=13); Bleeding (n=4); Physiological parameters (n=2); Lip or cheek biting/numbness (n=4); Postoperative anxiety (n=2) |
| Study designs | Parallel group or split mouth randomised controlled trials (quasi-randomised and cross-over trials ineligible) | Parallel group RCTs (n=13); Split mouth RCT (n=1) |
Search date: 2014-01-02. Databases: Cochrane Oral Health Group Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 12); MEDLINE via OVID (1946 to 2 January 2014); EMBASE via OVID (1980 to 2 January 2014); Web of Science Conference Proceedings (1990 to 2 January 2014); US National Institutes of…
Questions and results
Current version onlyInfiltration injection local anaesthetic vs No treatment or placebo
Population: Children and young people aged 17 years or younger having dental treatment (including extractions) under general anaesthesia (secondary care)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Parental satisfaction | No study reported parental satisfaction | 0 studies | No studies |
Intraoperative or postoperative bleeding | Because of substantial clinical and methodological heterogeneity in the studies, we were unable to determine an estimate of effect | 2 studies · 174 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Postoperative pain or distress Postoperatively, typically up to discharge | Because of substantial clinical and methodological heterogeneity in the studies, we were unable to determine an estimate of effect | 6 studies · 542 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Participant satisfaction | None of the studies reported on patient or child satisfaction | 0 studies | No studies |
Lip or cheek biting | Coulthard 2006: lip/cheek biting 3/70 (LA) vs 1/69 (placebo), P=0.62; Townsend 2009: 4/11 vs 1/12, P=0.16; no statistically significant difference | 2 studies · 162 participants | Ungraded |
Postoperative anxiety | None of the studies reported on postoperative anxiety | 0 studies | No studies |
Physiological parameters (cardiac/respiratory events; type and volume of GA drug) | Because of substantial clinical and methodological heterogeneity in the studies, we were unable to determine an estimate of effect | 2 studies · 148 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Intraligamental injection local anaesthetic vs No treatment
Population: Children and young people aged 17 years or younger having dental treatment (including extractions) under general anaesthesia (secondary care)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Intraoperative or postoperative bleeding | None of the studies reported on this outcome | 0 studies | No studies |
Postoperative pain On regaining consciousness, up to 1 hour (1 study to 48 hours) | Because of substantial clinical and methodological heterogeneity in the studies, we were unable to determine an estimate of effect | 2 studies · 115 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Postoperative anxiety | Anand 2005 used the Venham Picture Scale but, owing to the split-mouth design, postoperative anxiety could not be compared between the LA and no-treatment sides | 1 study | Ungraded |
Lip or cheek biting, numbness or allergy | Anand 2005: no signs of postoperative soft tissue trauma, 21 children reported numbness on the LA (experimental) side; Sammons 2007: no adverse events reported | 2 studies | Ungraded |
Physiological parameters (cardiac/respiratory events; type and volume of GA drug) | None of the studies reported on this outcome | 0 studies | No studies |
Parental satisfaction | No study reported parental satisfaction | 0 studies | No studies |
Participant satisfaction | The studies did not report on patient or child satisfaction | 0 studies | No studies |
Infiltration injection LA and intraligamental injection LA (3-arm) vs No treatment
Population: Children and young people aged 17 years or younger having dental treatment (including extractions) under general anaesthesia (secondary care)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participant satisfaction | The study did not report on patient or child satisfaction | 0 studies | No studies |
Intraoperative or postoperative bleeding | None of the studies reported on this outcome | 0 studies | No studies |
Physiological parameters (cardiac/respiratory events; type and volume of GA drug) | None of the studies reported on this outcome | 0 studies | No studies |
Parental satisfaction | No study reported parental satisfaction | 0 studies | No studies |
Lip or cheek biting, numbness or allergy | The study did not report on lip or cheek biting | 0 studies | No studies |
Postoperative pain or distress Up to 30 minutes postoperatively; parent-reported to first night | Because of substantial clinical and methodological heterogeneity in the studies, we were unable to determine an estimate of effect | 1 study · 54 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Postoperative anxiety | Postoperative anxiety (Venham Picture Test) measured in 52 children; not statistically significantly different among the three groups (P=0.23) | 1 study · 52 participants | Ungraded |
Topical local anaesthetic (spray or dental swab) vs Placebo or no treatment
Population: Children and young people aged 17 years or younger having dental treatment (including extractions) under general anaesthesia (secondary care)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Physiological parameters (cardiac/respiratory events; type and volume of GA drug) | None of the studies reported on this outcome | 0 studies | No studies |
Intraoperative or postoperative bleeding | Elhakim 1993 reported prolonged postoperative bleeding in the no-treatment group; Andrzejowski 2002 reported no difference in bleeding (nurse-assessed 'mild' in both groups) | 2 studies · 160 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Lip or cheek biting | None of the studies reported on lip or cheek biting | 0 studies | No studies |
Postoperative pain or distress Postoperatively, typically up to discharge (5 to 60 minutes) | Because of substantial clinical and methodological heterogeneity in the studies, we were unable to determine an estimate of effect | 4 studies · 343 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Parental satisfaction | No study reported parental satisfaction | 0 studies | No studies |
Participant satisfaction | None of the studies reported on patient or child satisfaction | 0 studies | No studies |
Postoperative anxiety | None of the studies reported on postoperative anxiety | 0 studies | No studies |
Any local anaesthetic (including type/dose/method) given during dental treatment under general anaesthesia vs Placebo or no local anaesthetic
Population: Participants aged up to 17 years having dental treatment including orthodontic treatment, fillings, removal of the nerve from a tooth, and extraction of a tooth under general anaesthesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pain measures (intensity, or presence or absence of pain) | no estimate extracted | NR | No studies |
Intraoperative or postoperative bleeding | no estimate extracted | NR | No studies |
Type and volume of general anaesthetic drug administered | no estimate extracted | NR | No studies |
Incidence of postoperative lip-biting or cheek-biting, prolonged numbness or allergy | no estimate extracted | NR | No studies |
Patient satisfaction | no estimate extracted | NR | No studies |
Preoperative/postoperative anxiety | no estimate extracted | NR | No studies |
Parental satisfaction | no estimate extracted | NR | No studies |