Postoperative Pain and Other Sequelae of Dental Rehabilitations Performed on Children Under General Anesthesia

Department of Pediatric Dentistry

Lutheran Medical Center

 

Resident’s Name:  Chad Abby                                    Date: 5/29/2009

Article title:  Postoperative Pain and Other Sequelae of Dental Rehabilitations Performed on Children Under General Anesthesia

Author(s): Howard Needleman, Sandhya Harpavat, Sam Wu, Elizabeth Allred, Charles Berde

Journal:  Pediatric Dentistry

 Volume (number): Vol. 30, No. 2

Month, Year:  2008

Major topic:  General Anesthesia

 Minor topic(s:  Postoperative pain of dental rehabilitation performed on children under GA

Type of Article:  Scientific Article

Main Purpose:  The purpose of this study was to determine the prevalence, severity and variables influencing postoperative pain and other sequelae in children undergoing dental rehabilitation under general anesthesia. 

Methods:  Healthy children scheduled for dental rehabilitation having treatment only on primary teeth were included in the study.  General anesthesia protocol was standardized and patients did not receive local anesthesia intraoperatively.  Pain and other postoperative sequelae were recorded for seven days postoperatively. 

Findings:  95% of the 90 children had postoperative pain which was moderate in intensity and highest immediately postoperatively.  Children who had an extraction or were at least 4 years old and had more then 12 procedures experienced, increased postoperative pain.  The most common postoperative symptoms other than pain were agitation, need for analgesics, and sleepiness.  Longer operative times resulted in increased postoperative sleepiness.  Children whose tracheal intubations were traumatic were more likely to report sore throats.  Children who were at least 4 years old required more analgesics, experienced more postoperative sleepiness and had nausea more frequently.  All postoperative problems significantly decreased by day 2 postoperatively and ceased by day four to five. 

Key points/Summary :  Children undergoing dental rehabilitation under general anesthesia commonly experience postoperative symptoms such as pain, agitation, need for analgesics, and sleepiness.  Children who have longer operative times are more likely to experience postoperative sleepiness.  This study used no intraoperative local anesthesia nor were there any standard orders for the use of postoperative analgesics to be given in the recovery room, which may explain why the children in this study had the highest rate of reported pain compared with other previous studies.  It was also found that children of less-educated parents were more likely to report pain in both the preoperative and PACU periods. 

Assessment of article:  Dentists often have limited contact with children immediately following treatment under general anesthesia so it is important to explain to parents what to expect and how to manage and reduce children’s postoperative emotional and physical distress.  The results were somewhat surprising to me considering how few parents tell us there children have postoperative pain or nausea following dental rehabilitation after general anesthesia.  Possibly parents feel more comfortable expressing pain or discomfort on questionnaires they fill out?  This is something the article mentioned in that the type of pain scale used was more of a self assessment scale.