Pilot study in France about the infiltration of local anaesthetics associated to oral surgery procedures performed under general anaesthesia

Abstract

Introduction: Opinions differ regarding the combined use of local anaesthesia (LA) and general anaesthesia (GA) in oral surgery procedures. The aim of this study was to evaluate practices in France concerning intraoperative LA for oral surgery performed under GA. Practitioners and method: We conducted a prospective survey of 250 oral surgery practitioners (CNIL-2045135v0 e) and carried out a literature review with the MEDLINE search engine (PubMed) covering the period from January 2000 to September 2017. Results: Among the 77 practitioners who participated, 88.3% were dental practitioners, the majority of whom were in the 25–34-yr age group. More than half (59%) infiltrated the surgical site; 46% pre-operatively, 24% intraoperatively and 11% post-operatively. Discussion: LA under GA appears to have advantages for post-operative pain management, dissection of the first mucosal plane and bleeding management pre- and post-operatively. The contraindications remain the same as for patients in a vigilant state. In children, it should be used in moderation to limit the risk of self-inflicted lip or mouth trauma during recovery. Conclusion: The indications of LA under GA are operator-dependent and the analysis of the literature did not allow us to determine the interest or not of LA administered intraoperatively during oral surgery performed under GA.

Professional Attitudes and Practice of Pediatric Dentists About the Use of Local Anesthesia for the Treatment of Children Under General Anesthesia

“…In research conducted by De Verbizier et al in France, local anesthesia was used during general anesthesia in more than half of the oral surgeries, leading to improved pain management and reduced preoperative and postoperative bleeding. For the remainder of the patients, local anesthesia was not used due to concerns about toxic and allergic reactions (15) In a randomized, prospective study, Townsend et al (as cited by Batarseh) concluded that administering local anesthesia after general anesthesia does not lessen pain or shorten the recovery duration; instead, it may lead to negative outcomes, such as an increased incidence of lip and cheek biting (13). According to these results, most participants did not believe that local anesthesia hastened patients' recovery, with only about 29% acknowledging its effectiveness in reducing recovery time.…”

“…A questionnaire developed by the researchers was employed to conduct the study. The questionnaire's items were inspired by a similar article (15) and modified after review in a meeting with one anesthesiologist, three pedodontists, and one community dentist. Preliminary tests were conducted with a group equal to at least 10% of the sample size, chosen randomly, to assess the questionnaire's reliability.…”

Rethinking the scope of oral medicine/oral surgery practice: 7 unusual must-know conditions for the oral surgeon

“…Trigemino-cardiac reflex is mostly observed during major oral and maxillofacial surgery procedures but has also been reported in tooth avulsion surgery [25,26] or even during root canal treatments [27]. The existence of such reflex advocates for proper preoperative local anesthesia to limit unwanted trigeminal afferent stimulation, even for procedures undertaken under general anesthesia [28].…”