Quintessence Int. 2021 Jul 20;52(8):706-712. doi: 10.3290/j.qi.b1492035.
Few studies have examined pain levels for the injection of local anesthesia in children, though it is a routine technique in pediatric dentistry. The objective of the study was to evaluate the difference in the assessment of procedural pain by the child, parent, dental practitioner, and independent observers during injection of local anesthesia for dental treatment in pediatric dentistry.
In total, 27 male and 22 female children (5 to 17 years of age, mean ± SD 9.8 ± 4.0 years) received local anesthesia (LA) via infiltration or mandibular alveolar blocks according to a standard protocol. After the dental treatment, the children assessed the pain levels for the procedures on a visual analog scale (VAS), while their parents and the dental practitioner used a numeric rating scale (0 to 10). Independent observers also assessed pain via video tape for an evaluation after blinding. The heart rate was monitored continuously during the procedure. The Bland-Altman method was used to quantify the comparison between pain ratings.
The assessed level of pain by dental practitioner, parent, and child during injection of LA differed clearly (child: 3.94 ± 2.71; parent: 3.31 ± 2.60; dental practitioner: 3.02 ± 1.98; video observer 1: 1.76 ± 2.56; video observer 2: 1.89 ± 2.55). In 42.9% of cases the dental practitioner's rating and the self--reported pain by the child during injection of LA differed by ≥ 2 on the numeric rating scale, which is clinically a highly different and relevant assessment.
As pain perception in children during the injection of local anesthetic and its assessment varies considerably depending on the assessing person and the treated child, dental practitioners and researchers should be cautious in interpreting the patient's pain perception.
尽管局部麻醉注射在儿童牙科中是一种常规技术，但很少有研究检查儿童注射局部麻醉的疼痛水平。本研究的目的是评估在儿童牙科中进行牙科治疗时，儿童、家长、牙医和独立观察者在注射局部麻醉时评估操作疼痛的差异。
共有 27 名男性和 22 名女性儿童（5 至 17 岁，平均 ± SD 9.8 ± 4.0 岁）根据标准方案通过浸润或下颌牙槽骨阻滞接受局部麻醉（LA）。在牙科治疗后，儿童使用视觉模拟量表（VAS）评估程序疼痛水平，而其父母和牙医使用数字评分量表（0 至 10）。独立观察者还通过录像评估疼痛，然后进行盲法评估。在整个过程中连续监测心率。使用 Bland-Altman 方法来量化疼痛评分之间的比较。
牙医、家长和儿童在注射 LA 期间评估的疼痛水平明显不同（儿童：3.94 ± 2.71；家长：3.31 ± 2.60；牙医：3.02 ± 1.98；视频观察者 1：1.76 ± 2.56；视频观察者 2：1.89 ± 2.55）。在 42.9%的情况下，牙医的评分和儿童在注射 LA 期间自我报告的疼痛程度在数字评分量表上相差≥2，这在临床上是一种高度不同且相关的评估。
由于儿童在接受局部麻醉注射时的疼痛感知以及评估因人而异，且与接受治疗的儿童有关，因此牙医和研究人员在解释患者的疼痛感知时应谨慎。
