Post-operative oral surgery pain: a review
P. Coulthard,
P. Coulthard
Oral and Maxillofacial Surgery, School of Dentistry, The University of Manchester, Manchester, UK
Search for more papers by this author
P. Coulthard,
P. Coulthard
Oral and Maxillofacial Surgery, School of Dentistry, The University of Manchester, Manchester, UK
Search for more papers by this author
Professor P Coulthard
Oral and Maxillofacial Surgery
School of Dentistry
The University of Manchester
Higher Cambridge Street
Manchester M15 6FH
UK
Tel: +44 161 275 6677
Fax: +44 161 275 6631
Email: [email protected]
Oral and Maxillofacial Surgery
School of Dentistry
The University of Manchester
Higher Cambridge Street
Manchester M15 6FH
UK
Tel: +44 161 275 6677
Fax: +44 161 275 6631
Email: [email protected]
Abstract
This review article describes the scientific basis of contemporary management of pain after oral surgery. Management can be challenging but significant improvement can be made to the patient's experience by patient education, staff education and the use of an evidence-based analgesic protocol.
References
- 1 Tong D, Chung F, Wong D. Predictive factors in global and anesthesia satisfaction in ambulatory surgical patients. Anesthesiology 1997; 87: 856–64.
- 2 Apfelbaum JL, Chen C, Shilpa S, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003; 97: 534–40.
- 3 Rawal N, Hylander J, Nydahl PA. Survey of postoperative analgesia following ambulatory surgery. Acta Anaesthesiol Scand 1997; 41: 1017–22.
- 4 Bolles RC, Fanshaw MS. A perceptual-defensive-recuperative model of fear and pain. Behav Brain Sci 1980; 3: 291–301.
- 5 Treede RD, Meyer RA, Raja SN, Cambell JN. Peripheral and central mechanisms of cutaneous hyperalgesia. Prog Neurobiol 1992; 38: 397–421.
- 6 Treede RD, Margerl W. Multiple mechanisms of secondary hyperalgesia. Prog Brain Res 2000; 129: 331–41.
- 7 Lewin GR, Moshourab R. Mechanosensation and pain. J Neurobiol 2004; 61: 30–44.
- 8 Woolf CJ. Somatic pain – pathogenesis and prevention. Br J Anaesth 1995; 75: 169–76.
- 9 Woolf CJ, Chong MS. Preemptive analgesia – treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993; 77: 1–18.
- 10 Cousins MJ, Power I. Acute and postoperative pain. In: PD Wall, R Melzack, editors: Texbook of Pain, 4th edition. Edinburgh, UK: Churchill Livingstone, 2000: 447–91.
- 11 Joshi GP, Ogunnaike B. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North America 2005; 23: 21–36.
- 12 Kehlet H, Jenson TS, Woolf C. Persistent postsurgical pain: risk factors and prevention. Lancet 2006; 367: 1618–25.
- 13 Merskey H. Logic, truth and language in concepts of pain. Qual Life Res 1994; 3(Suppl.1): S69–76.
- 14 Besson JM. The neurobiology of pain. Lancet 1999; 353: 1610–5.
- 15 Dickenson AH. Spinal cord pharmacology of pain. Br J Anaesth 1995; 75: 193–200.
- 16 Fust S. Transmitters involved in antinociception in the spinal cord. Brain Res Bull 1999; 48: 129–41.
- 17 Loeser JD, Melzack R. Pain: an overview. Lancet 1999; 353: 1607–9.
- 18 Dray A. Tasting the inflammatory soup: a role of peripheral neurones. Pain Rev 1994; 1: 153–71.
- 19 Schaible HG, Grubb BD. Afferent and spinal mechanisms of joint pain. Pain 1993; 55: 50–4.
- 20 Dray A, Urban L, Dickenson AH. Pharmacology of chronic pain. Trends Pharmacol Sci 1994; 15: 190–7.
- 21 McQuay HJ, Dickenson AH. Implications for central nervous system plasticity for pain management. Anaesth 1990; 45: 101–2.
- 22 Dickenson AH. A cure for wind-up: NMDA receptor antagonists as potential analgesics. Trends Pharmacol Sci 1990; 11: 307–9.
- 23 Dickenson AH, Sullivan AF. Differential effects of excitatory amino-acid antagonists on dorsal horn niciceptive neurones in the rat. Brain Res 1990; 506: 31–9.
- 24 Cook AJ, Woolf CJ, Wall PD, McMahon SB. Dynamic receptor field plasticity in the rat spinal dorsal horn following C-primary afferent input. Nature 1987; 325: 151–3.
- 25 Esposito M, Coulthard P. Wisdom teeth. In: C Young, editor: Clinical Evidence. London: British Medical Journal Publishing Group, 2008: 464–5.
- 26 Cooper SA, Beaver WT. A model to evaluate mild analgesia in oral outpatients. Clin Pharmacol Ther 1976; 20: 241–50.
- 27 Fisher SE, Frame JW, Rout PG, McEntegart DJ. Factors affecting the onset and severity of pain following the surgical removal of unilateral impacted mandibular third molar teeth. Br Dent J 1988; 164: 351–4.
- 28 Seymour RA, Meechan JG, Blair GS. An investigation into post-operative pain after third molar surgery under local analgesia. Br J Oral Maxillofac Surg 1985; 23: 410–8.
- 29 Seymour RA, Blair GS, Wyatt FA. Postoperative dental pain and analgesic efficacy. Part1. Br J Oral Surg 1983; 21: 290–7.
- 30 Coulthard P, Haywood D, Tai MA, Jackson D, Pleuvry BJ, MacFarlane T. Treatment of postoperative pain in oral and maxillofacial surgery. Br J Oral Maxillofac Surg 2000; 38: 588–92.
- 31 Ready LB, Oden R, Chadwick HS. Development of an anaesthesiology-based postoperative pain service. Anesthesiology 1988; 68: 100–6.
- 32 Slappendal R, Weber E, Bughter M, Dirksen R. The intensity of preoperative pain is directly correlated with the amount of morphine needed. Anesth Analg 1999; 88: 146–8.
- 33 Coulthard P, Oliver R, Afridi KAK, Jackson-Leech D, Adamson L, Worthington HV. The efficacy of local anaesthetic for pain after iliac bone harvesting: a randomised controlled trial. Int J Surg 2008; 6: 57–63.
- 34 Rawal N, Sjostrand U, Christoffensson E, Dahlstrom B, Avril A, Raymond H. Comparisons of intramuscular and epidural morphine for postoperative analgesia in the grossly obese: influence on postoperative ambulation and pulmonary function. Anesth Analg 1984; 63: 583–92.
- 35 Cullen ML, Staren ED, El Ganzouri A, Logas WG, Ivankovitch AD, Economov SG. Continuous epidural infusion for analgesia after major abdominal operations: a randomised prospective double blind study. Surgery 1985; 98: 718.
- 36 Cousins MJ. Acute pain and the injury response: immediate and prolonged effects. Reg Anesth 1989; 14: 162–78.
- 37 Ready LB, Ashburn M, Caplin RA. Practice guidelines for acute pain management in the peri-operative setting – a report of the American Society of Anesthesiologists task force on pain management. Anesthesiology1995; 82: 1071–81.
- 38 Gray A, Kehlet H, Bonnet F, Rawel N. Predicting postoperative analgesia outcomes: NNT league tables or procedure-specific evidence?. Br J Anaesth 2005; 94: 710–4.
- 39 Chung F, Richie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg 1997; 85: 808–16.
- 40 Moore RA, McQuay HJ. Single-patient data meta-analysis of 3453 postoperative patients: oral tramadol versus placebo, codeine and combination analgesics. Pain 1997; 69: 287–94.
- 41 Barden J, Edwards JE, McQuay HJ, Moore RA. Pain and analgesic response after third molar extraction and other postsurgical pain. Pain 2004; 107: 86–90.
- 42 Barden J, Edwards J, Moore A, McQuay H. Single dose oral paracetamol (acetaminophen) for postoperative pain. Cochrane Database Syst Rev 2004;( 1):CD004602.
- 43 Moore RA, Collins S, Carroll D, McQuay H, Edwards J. Single dose paracetamol (acetaminophen), with and without codeine, for postoperative pain. Cochrane Database Syst Rev 2000;( 2):CD001547.
- 44 Day RO, Graham GG, Whelton A. The position of paracetamol in the world of analgesics. Am J Ther 2000; 7: 51–4.
- 45 Botting RM. Mechanism of action of acetaminophen: is there cyclooxygenase 3? Clin Infect Dis 2000; 5: 202–10.
- 46 Chandrasekharan NV, Dai H, Roos KL, Evanson NK, Elton TS. COX-3 a cyclooxgenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: cloning structure and expression. Proc Natl Acad Sci U S A 2002; 99: 13926–31.
- 47 Kehlet H, Werner MU. Role of paracetamol in the acute pain management. Drugs 2003; 63: 15–22.
- 48 Joshi GP. Multimodal analgesia techniques for ambulatory surgery. Int Anesthesiol Clin 2005; 43: 215–8.
10.1097/00004311-200504330-00023 Google Scholar
- 49 Larson AM, Polson J, Fontana RJ. Acetaminophen-induced acute liver failure: results of a United States multicentre prospective study. Hepatology 2005; 42: 1364–72.
- 50 Chan AT, Manson JE, Albert CM. Nonsteroidal antiinflammatroy drugs, acetaminophen and risk of cardiovascular events. Circulation 2006; 113: 1578–87.
- 51 Mehlisch DR, Sollecito WA, Helfrick JF, Leibold DG, Markowitz R, Schow CE Jr.. Multicenter clinical trial of ibuprofen and acetaminophen in the treatment of postoperative dental pain. Journal Am Dent Assoc 1990; 121: 257–63.
- 52 Kiersch TA, Halladay SC, Hormel PC. A single-dose, double-blind comparison of naproxen sodium, acetaminophen, and placebo in postoperative dental pain. Clin Ther 1994; 16: 394–404.
- 53 Skoglund LA, Skjelbred P, Fyllingen G. Analgesic efficacy of acetaminophen 1000 mg, acetaminophen 2000 mg, and the combination of acetaminophen 1000 mg and codeine phosphate 60 mg versus placebo in acute postoperative pain. Pharmacotherapy 1991; 11: 364–9.
- 54 Seymour RA, Hawkesford JE, Sykes J, Stillings M, Hill CM. An investigation into the comparative efficacy of soluble aspirin and solid paracetamol in postoperative pain after third molar surgery. Br Dent J 2003; 194: 153–7.
- 55 Weil K, Hooper L, Afzal Z, Esposito M, Worthington HV, Van Wijk A et al. Paracetamol for pain relief after surgical removal of wisdom teeth. Cochrane Database Syst Rev 2007;( 3):CD004487.
- 56 Hahn TW, Mogensen T, Lund C. Analgesic effect of iv paracetamol: possible ceiling effect of paracetamol in postoperative pain. Acta Anaesthesiol Scand 2003; 47: 138–45.
- 57 Miranda HF, Puig MM, Prieto JC, Pinardi G. Synergism between paracetamol and nonsteroidal anti-inflammatory drugs in experimental acute pain. Pain 2006; 121: 22–8.
- 58 Toms L, Derry S, Moore RA, McQuay HJ. Single dose paracetamol (acetaminophen) with codeine for postoperative pain in adults. Cochrane Database Syst Rev 2009;( 1):CD001547.
- 59 Coulthard P, Hill M, Frame JW, Barry H, Ridge D, Bacon TH. Pain control with paracetamol from a sustained release formulation and a standard release formulation after third molar surgery: a randomised control trial. Br Dent J 2001; 191: 319–24.
- 60 Dubois RN, Abramson SB, Crofford L. Cyclooxygenase in biology and disease. FASEB J1998; 12: 1063–73.
- 61 Lipsky PE, Abramson SB, Crofford L. The classification of cycloogygenase inhibitors. J Rheumatol 1998; 25: 2298–303.
- 62 Patrono C, Dunn MJ. The clinical significance of inhibition or renal prostaglandin synthesis. Kidney Int 1987; 32: 1–12.
- 63 Malmberg AB, Yaksh TL. Antinociceptive effects of spinal non-sterioidal anti-inflammatory agents on the formalin test in the rat. J Pharmacol Exp Ther 1992; 263: 136–46.
- 64 Winter L, Bass E, Recant B, Cahaly JF. Analgesic activity of ibuprofen (Motrin) in postoperative oral surgical pain. Oral Surg Oral Med Oral Pathol 1978; 45: 159–66.
- 65 Seymour RA, Frame J, Negus TW, Hawkesford JE, Marsden J, Matthew IR. The comparative efficacy of aceclofenac and ibuprofen in postoperative pain after third molar surgery. Br J Oral Maxillofac Surg 1998; 36: 375–9.
- 66 Hersh EV, Levin LM, Cooper SA, Doyle G, Waksman J Wedell D et al. Ibuprofen liquigel for oral surgery pain. Clin Ther 2000; 22: 1306–18.
- 67 Kenny GNC. Potential renal, haematological and allergic adverse effects associated with nonsteroidal anti-inflammatory drugs. Drugs 1992; 44: 31–7.
- 68 Graham DJ. COX-2 inhibitors, other NSAIDs and cardiovascular risk. The seduction of common sense. J Am Med Assoc 2006; 296: 1653–6.
- 69 Strom BL, Berlin JA, Kinman JL. Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. J Am Med Assoc 1996; 275: 376–82.
- 70 Hill CM, Sindet-Pederson S, Seymour RA, Hawkesford JE, Coulthard P, Lamey P et al. Analgesic efficacy of the cyclooxygenase-inhibiting nitric oxide donor AZD3582 in postoperative dental pain: comparison with naproxen and rofecoxib in two randomized, double-blind, placebo-controlled studies. Clin Ther 2006; 28: 1279–95.
- 71 Esser R, Berry C, Du Z. Preclinical pharmacology of lumiracoxib: a novel selective inhibitor of cyclooxygenase-2. Br J Pharmacol 2005; 144: 538–50.
- 72 Zang J, Ding EL, Song Y. Adverse effects of cyclooxygenase 2 inhibitors on renal and arrhythmia events – meta-analysis of randomised trials. J Am Med Assoc 2006; 296: 1619–32.
- 73 Gajraj NM, Joshi GP. Role of cyclooxygenase-2 inhibitors in postoperative pain management. Anesthesiol Clin North America 2005; 23: 49–72.
- 74 Gilron I, Milne B, Hong M. Cyclooxygenase-2 inhibitors in postoperative pain management. Anesthesiology 2003; 99: 1198–208.
- 75 McGettigan P, Henry D. Cardiovascular risk and inhibition of cyclooxygenase studies of selective and non-selective inhibitors of cyclooxygenase 2. JAMA 2006; 296: 1633–44.
- 76 Kearney PM, Baigent C, Godwin J. Do selective cyclooxygenase 2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ 2006; 332: 1302–8.
- 77 Seymour RA, Moore U, Hawkesford J, Coulthard P, Jackson-Leech D, Thomas D et al. An investigation into the efficacy of intravenous diclofenac in postoperative dental pain. Eur J Clin Pharmacol 2000; 56: 447–52.
- 78 Coulthard P, Snowdon AT, Rood JP. The efficacy of postoperative pain management with ketorolac for day case surgery. Ambulatory Surg 1995; 4: 199–203.
10.1016/0966-6532(96)00005-4 Google Scholar
- 79 Tramer MR, Williams JE, Carroll D. Comparing analgesic efficacy of non-steroidal anti-inflammatory drugs given by different routes in acute and chronic pain: a quantitative systematic review. Acta Anaesthesiol Scand 1998; 42: 71–9.
- 80 Rang HP, Dale MM, Ritter JM, Flower R. Rang and Dale's Pharmacology, 6th edition. Edinburgh, UK: Churchill Livingstone, 2007
- 81 Redpath JB, Pleuvry BJ. Double-blind comparison of the respiratory and sedative effects of codeine phosphate and (+–)-glausine phosphate in human volunteers. Br J Clin Pharmacol 1982; 14: 555–8.
- 82 Martin WR. Pharmacology of opioids. Pharmacol Rev 1983; 53: 283–323.
- 83 Hudcova J, McNicol E, Quah C. Patient controlled intravenous opioid analgesia versus conventional opioid analgesia for postoperative pain control: a quantitative systematic review. Acute Pain 2005; 7: 115–32.
- 84 Smith CF. Morphine, but not diacetyl morphine (heroin) possess opiate analgesic activity in the mouse vas deferens. Neuropeptides 1984; 5: 173–6.
- 85 Sawynok J. The therapeutic use of heroin: a review of the pharmacological literature. Can J Physiol Pharmacol 1986; 64: 1–6.
- 86 Reisine T, Pasternak G. Opioid analgesics and antagonists. In: JG Hardman, LE Limbird, AG Gilman, editors: Goodman and Gillma's The Pharmacological Basis of Therapeutics, 9th edition. New York: McGraw-Hill, 1996: 521–55.
- 87 Coulthard P, Snowdon AT, Rood JP. The efficacy and safety of postoperative pain management with tramadol for day case surgery. Ambul Surg 1996; 4: 25–9.
10.1016/0966-6532(96)00108-4 Google Scholar
- 88 Wilhelm S, Maze M. Controversial issues in adult and pediatric ambulatory anesthesia; is there a role for the alpha-2 agonists in conscious sedation with adults and pediatric ambulatory surgical practice? Curr Opin Anaesthesiol 2000; 13: 619–24.
- 89 Maze M, Tranquilli W. Alpha-2 adrenoceptor agonists: defining the role in clinical anesthesia. Anesthesiology 1991; 74: 581–605.
- 90 Yoshitomi T, Kohjitani A, Maeda S, Huguchi H, Shimada M, Miyawaki T. Dexmedetomidine enhances the local anaesthetic action of lidocaine via an alpha-2A adrenoreceptor. Anesth Analg 2008; 107: 96–101.
- 91 Joshi GP. Recent developments in regional anaesthesia for ambulatory surgery. Curr Opin Anaesthesiol 1999; 12: 643–7.
- 92 Ogawa S, Seino H, Ito H, Yamazaki S, Ganzberg S, Kawaai H. Intravenous sedation with low-dose dexmedetomidine: its potential for use in dentistry. Anesth Prog 2008; 55: 82–8.
- 93 Unlugenc H, Gunduz M, Guler T, Yagmur O, Isik G. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur J Anaesthesiol 2005; 22: 386–91.
- 94 Gilron I. Corticosteroids in postoperative pain management: future research directions for a multifaceted therapy. Acta Anaesthesiol Scand 2004; 48: 1221–2.
- 95 Aasboe V, Raeder JC, Groegaard B. Betamethasone reduces postoperative pain and nausea after ambulatory surgery. Anesth Analg 1998; 87: 319–23.
- 96 Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration – pathophysiological effect in clinical implications. J Am Coll Surg 2002; 195: 694–711.
- 97 Simjee SU, Pleuvry BJ, Coulthard P. Modulation of the gait deficit in arthritic rats by infusions of muscimol and bicuculline. Pain 2004; 109: 453–60.
- 98 Coulthard P, Simjee SU, Pleuvry BJ. Gait analysis as a correlate of pain induced by carrageenan intraplantar injection. J Neurosci Methods 2003; 128: 95–102.
- 99 Haley JE, Sullivan AF, Dickenson AH. Evidence for spinal N-methyl-d-aspartate receptor involvement in prolonged chemical nociception in the rat. Brain Res 1990; 518: 218–22.
- 100 Wahlander S, Frumento RJ, Wagener G. A prospective double-blind study of dexmedetomidine as an adjunct to epidural analgesia after thoracic surgery. J Cardiothorac Vasc Anesth 2005; 19: 630–5.
- 101 Munoz R, Berry D. Dexmedetomidine: promising drug for pediatric sedation? Pediatr Crit Care Med 2005; 6: 493–4.
- 102 Tobias JD, Berkenbosch JW, Russo P. Additional experience with dexmedetomidine in pediatric patients. South Med J 2003; 96: 871–5.
- 103 Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a quantitative review. Br J Anaesth 2002; 88: 199–214.
- 104 McQuay HJ, Moore RA. Dose-response in direct comparisons of different doses of aspirin, ibuprofen and paracetamol (acetaminophen) in analgesic studies. Br J Clin Pharmacol 2007; 63: 268–70.
- 105 Toms L, McQuay HJ, Derry S, Moore RA. Single dose oral paracetamol (acetaminorphen) for postoperative pain in adults. Cochrane Database Syst Rev 2008;( 4):CD004602.
- 106 Moore RA, Collins S, Carroll D, McQuay H. Paracetamol with or without codeine in acute pain: a quantitative systematic review. Pain 1997; 70: 193–201.
- 107 Coulthard P, Pleuvry BJ, Dobson M, Price M. Behavioural measurement of postoperative pain after oral surgery. Br J Oral Maxillofac Surg 2000; 38: 127–31.
- 108 Coulthard P. Control of pain and anxiety. In: P Coulthard, K Horner, P Sloan, E Theaker, editors: Master Dentistry, Oral and Maxillofacial Surgery, Radiology, Pathology And Oral Medicine, 2nd edition. Edinburgh, UK: Churchill Livingstone, 2008: 46–7.
- 109 World Health Organization. The World Health Report 1998: Health in the 21st Century: A Vision for All. Geneva, Switzerland: WHO, 1998.
- 110 Jenkins C. Recomending analgesics for people with asthma. Am J Ther 2000; 7: 55–61.
- 111 Falliers CJ. Concerns regarding OTC analgesic use by allergic or asthmatic patients. Aspirin sensitivity and related conditions. Postgrad Med J 1996; special report: 42–6.
- 112 Eccles M, Freemantle N, Mason J. North of England evidence based guidelines development project: summary guideline for non-steroidal ant-inflammatory drugs versus basic analgesia in treating the pain of degenerative arthritis. BMJ 1998; 317: 530.
- 113 Kwoh CK, Fernstein AR. Rates of sensitivity reactions to aspirin: problems in interpreting the data. Clin Pharmacol Ther 1986; 40: 494–505.
- 114 Craig TJ. Drugs to be used with caution in patients with asthma. Am Fam Physician 1996; 54: 947–53.
- 115 Szczeklik A, Gryglewski RJ, Czerniawaka-Mysik G. Clinical patterns of hypersensitivity to non-steroidal antiinflammaotory drugs and their pathogenesis. J Allergy Clin Immunol 1977; 60: 276–84.
- 116 Stevenson DD. Diagnosis, prevention and treatment of adverse reactions to aspirin and nonsteroidal anti-inflammatroy drugs. J Allergy Clin Immunol 1984; 74: 617–22.
- 117 Popa V. Codeine-induced bronchoconstriction and putative bronchial opiate receptors in asthmatic subjects. Pulm Pharmacol 1994; 7: 333–41.
- 118 Lamb C, Cantrill JA. Asthma patients' usage of over-the-counter medicines and complimentary remedies. Pharm J 1995; 254: 802–4.
- 119 Szczeklik A, Nizankowask E, Mastalerz L, Szabo Z. Analgesics and asthma. Am J Ther 2002; 9: 233–43.
- 120 Morassut P, Yang W, Karsh J. Aspirin intolerance. Semin Arthritis Rheum 1989; 19: 22–30.
- 121 Dickenson AH, Sullivan AF. Evidence for a role of the NMDA receptor in the frequency dependent potentiation of deep rat dorsal horn nociceptive neurons following C fibre stimulation. Neuropharmacology 1987; 26: 1235–8.
- 122 Dahl JB, Kehlet H. The value of pre-emptive analgesia in the treatment of postoperative pain. Br J Anaesth 1993; 70: 434.
- 123 McQuay HJ. Pre-emptive analgesia: a systematic review of clinical studies. Ann Med 1995; 27: 249–56.
- 124 Bromley L. Pre-emptive analgesia and protective premedication. What is the difference? Biomed Pharmacother 2006; 60: 336–40.
- 125 Pogatzki-Zahn EM, Zahn PK. From preemptive to preventive analgesia. Curr Opin Anaesthesiol 2006; 19: 551–5.
- 126 Pogatzki-Zahn EM, Zahn PK. Systematic analgesia: an update. Anesthesiol Intensivmed Notfallmed Schmerzther 2007; 42: 22–31.
- 127 Coulthard P, Rolfe S, Mackie IC, Gazal G, Morton M, Jackson-Leech D. Intraoperative local anaesthesia for paediatric postoperative oral surgery pain – a randomised controlled trial. Int J Oral Maxillofac Surg 2006; 35: 1114–9.
- 128 Rood JP, Coulthard P, Snowdon AT, Glennery BA. Safety and efficacy of levobupivacaine for postoperative pain relief after the surgical removal of impacted third molars: a comparison with lignocaine and adrenaline. Br J Oral Maxillofac Surg 2002; 40: 491–6.
- 129 Chapman PJ, Ganendran A. Prolonged analgesia following preoperative bupivacaine neural blockade for oral surgery performed under general anesthesia. J Oral Maxillofac Surg 1987; 45: 233–5.
- 130 Danielsson K, Evers H, Holmlund A, Kjellman O, Nordenram A, Persson NE. Long acting local anaesthetics in oral surgery. Clinical evaluation of bupivacaine and etidocaine for mandibular nerve block. Int J Oral Maxillofac Surg 1986; 15: 119–26.
