Dor e ansiedade relacionadas à anestesia local para tratamento odontológico em crianças: avaliação de técnicas alternativas

Abstract

The aim of this thesis was to determine if the local anesthetic technique has influence in pain, anxiety and disruptive behavior in children, considering the conventional, vibrational and computerized techniques through systematic review, meta-analysis and two randomized clinical trial (RCT). Study 1 was conducted to answer the acronym PICO: Does computerized local anesthesia generate less pain and disruptive behavior in children compared to conventional techniques during local anesthesia for dental treatment? A search for RCT evaluating pain and behavior during computerized anesthesia in children was performed, compared to the conventional technique. Bases like PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library and gray literature were evaluated. The Cochrane Collaboration bias risk classification tool was used for qualitative evaluation of the studies. A total of 8,389 articles were identified. Twenty articles were analyzed in the qualitative and quantitative synthesis. High heterogeneity was detected for pain perception and disruptive behavior results. In pain perception, the overall analysis showed a standard mean difference of -0.78 (-1.31, -0.25) in favor of computerized; However, when only studies with low risk of bias were analyzed (subgroup analysis), there was no difference between the two techniques [-0.12 (-0.46, 0.22)]. For disruptive behavior, no difference was detected for continuous [-0.26 (-0.68, 0.16)] or dichotomous [0.81 (0.62, 1.06)] data. The quality of the evidence was considered low for pain perception and very low for disruptive behavior. Study 2 was a parallel randomized clinical trial of 105 children aged 5 to 8 years who required a dental procedure with local anesthesia in the posterior maxilla. Each group of 35 children received only one type of anesthesia; Conventional anesthesia (CA) or vibrational anesthesia (VBA) or computerized anesthesia (CCLAD). Self-perception of pain was assessed using the Wong-Baker Faces Pain Rating Scale (WBF) and Visual Analog Scale (VAS). Disruptive behavior was evaluated using the Face, Legg, Activity, Cry, Consolability Scale (FLACC). And anxiety was assessed by the modified Venham Picture test (VPTm). The physiological parameters were evaluated using a multiparameter monitor for blood pressure (SBP and DBP), heart rate (HR), oxygen saturation (SpO2) and respiratory rate (RR). Data were statistically analyzed using the Kruskall-Wallis test and ANOVA for repeated measures with Tukey post hoc. There is no difference in pain self-perception, either in WBF (p = 0.864) or VAS (p = 0.761); the disruptive behavior in FLACC (p = 0.318); anxiety with VPTm (p = 0.274); blood pressure in SBP (p = 0.239) and DBP (p = 0.512) in HR (p = 0.728); SpO2 (p = 0.348), RR (p = 0.238) between anesthetic techniques. Study 3 is a randomized clinical trial that followed the same methodology as study 2, differing only by the age group studied, in this, the children were 9 to 12 years old. The results showed that all patients exhibited the same level of dental anxiety at the baseline (Corah's Dental Anxiety Scale). There was a difference in pain perception, AC showed less pain than VBA considering WBF (p = 0.018) and NRS (p = 0.006) and less pain than CCLAD considering WBF (p = 0.029). There were no differences in disruptive behavior (FLACC - p = 0.573); anxiety (VPTm - p = 0.474); blood pressure (SBP - p = 0.954; DBP – p = 0.899); heart rate (p = 0.726); oxygen saturation (p = 0.477) and respiratory rate (p = 0.930) among all anesthetic techniques. According to the results obtained, the conventional technique is more suitable for performing infiltrative dental anesthesia in children. Dental anxiety and age group influence children's perception of pain under anesthesia.