Dental extractions in children: An audit of postoperative Pain, Nausea & Vomiting
Dr. Sundar Muthukrishnan
United Kingdom 
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10 slide(s) – English – 2011-09-08
Dental extractions in children: An audit of postoperative Pain, Nausea & Vomiting
Dr. Sundar Muthukrishnan, Dr. Gersten Jonker, SN. Vicky Fletcher, Dr. Sarah Hivey,
Royal Hospital for Sick Children, Yorkhill, Glasgow, United Kingdom
Background and Aim:
In adults pain following molar extractions can be very intense requiring strong analgesics1,2. Not many studies looked into pain following extractions of first permanent molars or ‘sixes’ in children. We looked into prospectively collected data to determine the relationship between number/ type of teeth extracted and intensity of pain/ sickness.
Methods:
101 consecutive patients aged 3-12 years, undergoing simple dental extractions of 2 or more teeth in a community dental setting were included in this study. After either inhalational or intravenous induction, the airway was secured with a flexible laryngeal mask airway and anaesthesia maintained with isoflurane in oxygen and air. Nitrous oxide was used as a supplementary inhalational agent in 50% of patients.
Intraoperative analgesics include local anaesthetic infiltration and paracetamol. Pain and postoperative nausea and Vomiting (PONV) scoring were done in the Recovery area, in Daycare Surgical Unit(DSU) at 30 minutes and just before discharge.
Results:
16 children had first permanent molars extracted (Group M) and the rest had deciduous teeth extracted (Group DT). The number of children requiring Non steroidal Anti-inflammatory drug (NSAID) rescue analgesics (25% vs 27%) and average time to first analgesic (44.5s vs 42.1s) were similar between group M and group DT. The average time to discharge is longer in Group M (01:50hrs) than Group DT (01:33hrs) but the difference was not statistically significant (p=0.27). Statistically significant difference (p=0.04) existed in number of children who stayed in the DSU for longer than 2 hours between Group DT (13.3%) and Group M (35.7%).
47 children had 6 or less teeth extracted (Group <6) and the rest had 7 or more teeth extracted (Group >6). The number of children requiring rescue analgesics, time to first analgesic, discharge time and children requiring longer than 2 hour stay were similar in these two groups
All children had pain scores of 0 in Recovery and in DSU before discharge. The pain scores in DSU at 30 min were similar in all four groups. Two patients in the Group DT and none in the Group M were sick in the DSU.
Conclusions
Intensity of pain is not related to type or number of teeth extracted. 25% of children required NSAIDs as rescue analgesic postoperatively. Children having molars extracted are at increased risk of prolonged stay in hospital, suggesting more distress. PONV is not a major problem in this patient group.
References
1. Severity of Baseline Pain and Degree of Analgesia in theThird Molar Post-Extraction Dental Pain Model. Mordechai Averbuch, MD et al, Anaes Analg 2003;97:163–7
2. The efficacy of combination analgesic therapy in relieving dental pain . Donald R. Mehlisch, The Journal of the American Dental Association July 1, 2002 vol. 133 no. 7 861-871 .
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