The efficacy of preoperative analgesic administration for postoperative pain management of pediatric dental patients. Management of postoperative pain in children following extractions of primary teeth under general anaesthesia: a comparison of paracetamol, Voltarol and no analgesia. Comparison of pre-emptive ibuprofen, paracetamol, and placebo administration in reducing post-operative pain in primary tooth extraction. Postoperative comfort in paediatric outpatient surgery. [Preventive analgesia and early postoperative period in ambulatory orthopedic surgeries in children].
Appropriate pain-management strategies for children receiving dental care continue to be poorly delineated. Recent studies have demonstrated the benefit of preoperative analgesic administration upon alteration of the postoperative pain experience in adults. It is the purpose of this study to assess the efficacy of preoperative administration of acetaminophen on the prevalence of postoperative pain-related behaviors and the frequency of postoperative analgesic use in 4- to 10-year-old children following various dental procedures. The results indicate a high prevalence of postoperative pain, independent of the type of dental procedure performed and the preoperative administration of acetaminophen. There is a trend toward reduced postoperative pain in the acetaminophen pretreatment groups. A greater sample size, with more reliable pain-assessment methods, may help to further elucidate the efficacy of preoperative analgesic administration in children. The clinician should be alerted to the potential for pain-related behaviors to occur following routine pediatric dental care. The aim of this study was to compare three different pain relief regimes and the respective levels of pain recorded by children undergoing extractions of primary teeth under general anaesthesia.
                This was a tri-sited study carried out in three similar hospital settings, each with a different pain relief protocol. The subjects were 70 children from each site who were aged between 3 and 12 years, and were undergoing routine extractions of primary teeth. All children from the three centres used a self-report visual analogue scale to record pain preoperatively and postoperatively (15 min after recovery), and relevant pain-relief medication was noted. The efficacy of the three different pain relief regimes was then compared.
                Children reported significantly less pain when rectal Voltarol was provided prior to the extractions, as compared to paracetamol or no analgesia. The greatest amount of pain was reported by the group who had received no analgesia.
                Voltarol appears to be the better pre-emptive analgesic for dental extractions under general anaesthesia when compared with paracetamol and no analgesia. This study investigates preliminary investigations that a pre-emptive analgesia administration may reduce post-extraction pain.
                This prospective, placebo-controlled, randomized, double-blind trial was planned to compare the efficacy of the pre-emptive administration of ibuprofen, paracetamol, and placebo in reducing post-extraction pain in children.
                Forty-five children, ages 6-12, who needed primary mandibular molar tooth extraction were treated in paediatric dental clinics, with treatment preceded by local anaesthesia and analgesic drugs during the preoperative period. A five-face scale was used to evaluate pain reaction during the injection, extraction, and post-operative period. Self-report scores were recorded when the local anaesthesia had been administered in soft tissues and both before and after the extraction was completed. The Kruskal-Wallis and Mann-Whitney U tests (with Bonferroni correction paired t-test as the post hoc test) were used at a confidence level of 95%.
                The use of pre-emptive analgesics showed lower scores compared to the placebo, irrespective of the age, weight, gender of the child, and the number of teeth extracted during the study period. Additionally, ibuprofen exhibited lower pain scores (P < 0.05) compared to paracetamol at the 15-min (P < 0.001) and 4-h (P < 0.009) periods.
                Preoperative use of ibuprofen and paracetamol may provide a pre-emptive analgesic effect in paediatric patients who receive adequate analgesia during mandibular primary tooth extraction.
                © 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd. Postoperative conditions in hospital and at home were evaluated in 200 paediatric daycase patients by using questionnaires and telephone interviews. Pain was assessed by behaviour observation or a faces rating scale depending on age. Anaesthetic methods, nausea/vomiting, analgesics and parents' aspects were also recorded. Seventy per cent of the patients received regional anaesthesia. Immediate postoperative analgesia was satisfactory in 75% of the children. When the effects of intraoperatively administered analgesics wore off at home almost half the children rated higher than mild pain. The increased degree of pain at home was especially pronounced after regional anaesthesia. The total incidence of nausea/vomiting was 28% and fentanyl caused nausea and vomiting in a significantly higher proportion of cases. The study points out that immediate postoperative comfort obtained by prophylactic analgesia needs to be followed by analgesics given on a continuous basis for the first days after surgery. The purpose of the case study was to compare the adequacy of anesthetic management and the specificity of the early postoperative course with preventive analgesia (group 1) and without it (group 2). Preventive analgesia comprised diclofenac, 50-75 mg/kg in intramuscular injections made 1 h before surgery, and microdoses of ketamine, 1.0 mg/kg in intramuscular injections 0.3 mg/kg in intravenous injections as a component of premedication. In as far as the hemodynamic course is concerned, both types of anesthesia were adequate. The main differences were registered in the assessment of the early postoperative period. An earlier awakening was observed in group 1, which we attributed to a more valuable antinociceptive protection and to lower doses of ketamine (group 1--3.2 mg/kg; group 2--4.3 mg/kg). According to the results the preventive analgesia method reduces significantly the postoperative pain and anxiety, which makes the administration of additional analgetics advisable and cuts the child's stay in one-day hospital.
From the available evidence we cannot determine whether or not preoperative analgesics are of benefit in paediatric dentistry for procedures under local anaesthetic. There is probably a benefit in prescribing preoperative analgesics prior to orthodontic separator placement.