DOI
https://doi.org/10.25772/JMBC-TB41
Defense Date
2024
Document Type
Thesis
Degree Name
Master of Science in Dentistry
Department
Dentistry
First Advisor
Elizabeth Bortell, DDS
Second Advisor
Jayakumar Jayaraman, BDS, MDS, FDSRCS, MS, PhD
Third Advisor
Caroline Carrico, PhD
Fourth Advisor
Jeannette Kierce, M.D., FAAP
Abstract
Purpose:
To determine the effect of local anesthesia on postoperative comfort in patients undergoing dental care under general anesthesia.
Methods:
This study was modeled as a double-blinded randomized control trial. Patients included healthy children under the age of 6 years scheduled for restorative dental treatment under general anesthesia (GA). Patient behavior was evaluated preoperatively and postoperatively using the Faces, Legs, Activity, Cry and Consolability (FLACC) or other pain score and postoperatively using the Parent’s Postoperative Pain Measure (PPPM). Intraoperatively, participants followed a standardized general anesthesia protocol and were given either local anesthetic (LA) infiltration using 2% Lidocaine 1:100,000 Epinephrine by the dental surgeon performing the surgery, or no local anesthesia was utilized. Patient’s time in the Post Anesthesia Care Unit (PACU) was noted upon discharge. The data were summarized with counts and percentages and means and standard deviations. Bivariate associations with postoperative distress and Parent’s Postoperative Pain Measure (PPPM) were assessed using Fisher’s Exact test. Significance level was set at 0.05.
Results:
A total of 31 children participated in the study, with 15 assigned to receive LA group and 16 assigned to not receive LA. Postoperatively, 35% of the patients demonstrated distress. When considering whether or not the child received local anesthesia, 19% of those who did not have local anesthesia demonstrated distress compared to 53% of those who did. Among those with less than 8 teeth treated, 57% demonstrated distress compared to 18% of those with 8 or more teeth treated. The Parent’s Postoperative Pain Measure (PPPM) was available for 23 of the 31 patients. Although not statistically significant, among those who did receive local anesthesia, 40% had positive PPPM scores compared to 69% of those who did not receive local anesthesia (P=.2215). Those who displayed postoperative distress also had a higher rate of positive PPPM than those who did not demonstrate postoperative distress, though not statistically significant (P=0.6600). The procedure time was marginally significantly related to the treatment (P=.0573).
Conclusion:
Use of local anesthesia in dental surgery under general anesthesia demonstrated a trend towards significance in increased postoperative distress. The number of teeth treated showed a statistically significant difference related to postoperative distress. There was no significant association between preoperative distress, LA administration, number of teeth treated, patient gender, and postoperative distress compared to PPPM score. Although not statistically significant, patients among the group that did receive LA demonstrated a lower PPPM score in comparison to the group that did not receive LA demonstrating less discomfort later that evening rather than immediately after the procedure, which could be contributed to less irritability from the diminished numbness sensation of local anesthesia.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
4-19-2024