Randomized controlled trial of the intraligamental use of a local anaesthetic (lignocaine 2%) versus controls in paediatric tooth extraction.

BACKGROUND

Children still experience pain upon waking following dental extraction under general anaesthesia. Local anaesthetic has been shown to reduce this pain, but needs to be administered via a method that causes minimum injury or distress to the child.

AIM

This study aims to evaluate the use of intraligamental injection of local anaesthetic, under general anaesthesia prior to the extraction of the tooth, for postoperative pain control in children aged 2-5 years.

DESIGN

A randomized, single-blind, controlled trial of intraligamental lignocaine (2% lignocaine solution with adrenaline (epinephrine) 1 : 80 000) for primary teeth extraction under general anaesthesia was performed. Pain was scored by the investigators at 5-, 15-, 30-, and 60-min time points in the first hour using the Toddler-Preschooler Postoperative Pain Scale.

RESULTS

Eighty-six children were recruited in the study: 42 randomized in the lignocaine treatment group and 44 in the control group. There was no significant difference (P = 0.42, Mann-Whitney U-test) in the cumulative four time point median pain score over the first hour. In the lignocaine treatment group, this was 3 (interquantile range (IQR) 0-7.5) and in the control group this was 3 (IQR: 0-10). At the 5-min time point after the child returned from recovery, the pain score in the lignocaine group (0 IQR 0-1) was statistically lower than that in the control group (0 IQR 0-5) (P = 0.023). There was no difference in the 15-, 30-, or 60-min time points.

CONCLUSIONS

Intraligamental lignocaine used for dental extraction under general anaesthesia in young children initially causes less pain after recovery, but this difference is not sustained over the first hour after dental extraction.