Anestesia local intraoperatoria para la reducción del dolor posoperatorio después de la anestesia general para el tratamiento odontológico de niños y adolescentes
Información
- DOI:
- https://doi.org/10.1002/14651858.CD009742.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 23 diciembre 2014see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Salud oral
- Copyright:
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- Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
Susan Parekh, Collette Gardener, Tanya Walsh, and Paul Ashley were responsible for preparation of the review, data extraction, and writing up.
Sources of support
Internal sources
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No sources of support supplied
External sources
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British Orthodontic Society (BOS), UK.
The BOS have provided funding for Cochrane Oral Health Global Alliance (see www.ohg.cochrane.org).
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New York University (NYU), USA.
NYU have provided funding for Cochrane Oral Health Global Alliance (see www.ohg.cochrane.org).
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British Society of Paediatric Dentistry (BSPD), UK.
The BSPD have provided funding for Cochrane Oral Health Global Alliance (see www.ohg.cochrane.org).
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National Institute for Health Research (NIHR), UK.
This project was supported by the NIHR, via Cochrane Infrastructure funding to Cochrane Oral Health. The views and opinions expressed are those of the authors and not necessarily those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health and Social Care.
Declarations of interest
Susan Parekh: nothing to declare.
Collette Gardener: nothing to declare.
Paul F Ashley: Paul Ashley was an author on one of the included studies (Leong 2007). He was not involved in the data extraction or any other decisions regarding this study.
Tanya Walsh: nothing to declare.
Acknowledgements
We would like to thank the Cochrane Oral Health Group editorial team and the referees for their helpful feedback and comments.
Version history
| Published | Title | Stage | Authors | Version |
| 2014 Dec 23 | Intraoperative local anaesthesia for reduction of postoperative pain following general anaesthesia for dental treatment in children and adolescents | Review | Susan Parekh, Collette Gardener, Paul F Ashley, Tanya Walsh | |
| 2012 Mar 14 | Intraoperative local anaesthesia for reduction of postoperative pain following general anaesthesia for dental treatment in children and adolescents | Protocol | Susan Parekh, Collette Gardener, David R Moles | |
Differences between protocol and review
The protocol indicated that only LA versus placebo or no LA was the stated comparison. In the published review, we added a comparison of active interventions (another local anaesthetic (including the type, dose, and method)). None of the included studies evaluated this comparison.
We removed preoperative anxiety as an outcome measure. This is an important baseline factor and is included in the 'Characteristics of included studies' tables where it has been measured and reported in a study.
The protocol stated that we would carry out a subgroup analysis with method of LA administration as a source of variation. Once we included the studies in the review, we decided that structuring the review according to method of LA administration was of most value to the clinician and provided greatest clarity to the reader. We acknowledge that this is a departure from the original protocol. Should sufficient studies allow, then we will investigate the subgroup analyses stated in the protocol within this structure.
We added age categories for the subgroup analysis for the review as this was not made explicit in the protocol. This was done to clarify how we would implement the subgroups.
Notes
This Cochrane Review is currently not a priority for updating. However, following the results of Cochrane Oral Health's latest priority setting exercise and if a substantial body of evidence on the topic becomes available, the review would be updated in the future.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- *Anesthesia, General;
- *Anesthesia, Local;
- Anesthetics, Local [*administration & dosage];
- Bupivacaine;
- Dental Care [*adverse effects];
- Epinephrine;
- Felypressin;
- Intraoperative Care [methods];
- Lidocaine;
- Pain, Postoperative [*prevention & control];
- Postoperative Hemorrhage [prevention & control];
- Prilocaine;
- Randomized Controlled Trials as Topic;
Medical Subject Headings Check Words
Adolescent; Child; Humans;
PICO
Study flow diagram
'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study
| Infiltration injection LA compared with placebo or no treatment for reduction of postoperative pain | |||
| Participant or population: children undergoing dental extractions under general anaesthetic Settings: secondary care Intervention: infiltration injection LA Comparison: placebo or no treatment | |||
| Outcomes | Number of participants | Quality of the evidence | Comments |
| Pain or distress (self‐ or investigator‐reported pain measured postoperatively typically up to discharge)1 | 542 (6 studies) | Very low ⊕⊝⊝⊝2 | Because of substantial clinical and methodological heterogeneity in the studies, we were unable to determine an estimate of effect |
| Bleeding | 174 (2 studies) | Very low ⊕⊝⊝⊝2 | Because of substantial clinical and methodological heterogeneity in the studies, we were unable to determine an estimate of effect |
| Physiological parameters | 148 (2 studies) | Very low ⊕⊝⊝⊝2 | Because of substantial clinical and methodological heterogeneity in the studies, we were unable to determine an estimate of effect |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||
| GRADE Working Group grades of evidence | |||
| 12 studies reported on postoperative pain up to 24 hours after discharge. | |||
| Intraligamental injection LA compared with no treatment for reduction of postoperative pain | |||
| Participant or population: children undergoing dental extractions under general anaesthetic Settings: secondary care Intervention: intraligamental injection LA Comparison: no treatment | |||
| Outcomes | Number of participants | Quality of the evidence | Comments |
| Pain (self‐ or investigator‐reported pain measured postoperatively on regaining consciousness and up to first hour following extraction)1 | 115 (2 studies) | Very low ⊕⊝⊝⊝2 | Because of substantial clinical and methodological heterogeneity in the studies, we were unable to determine an estimate of effect |
| Bleeding | ‐ | ‐ | None of the studies reported on this outcome |
| Physiological parameters | ‐ | ‐ | None of the studies reported on this outcome |
| *The basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||
| GRADE Working Group grades of evidence | |||
| 11 study also reported on postoperative pain up to 48 hours after discharge. | |||
| Infiltration injection LA compared with intraligamental injection LA with no treatment for reduction of postoperative pain | |||
| Participant or population: children undergoing dental extractions under general anaesthetic Settings: secondary care Intervention: infiltration injection LA, intraligamental LA Comparison: no treatment | |||
| Outcomes | Number of participants | Quality of the evidence | Comments |
| Pain or distress (Investigator‐reported pain measured postoperatively typically up to 30 minutes postoperatively)1 | 54 (1 study) | Very low ⊕⊝⊝⊝2 | Because of substantial clinical and methodological heterogeneity in the studies, we were unable to determine an estimate of effect |
| Bleeding | ‐ | ‐ | None of the studies reported on this outcome |
| Physiological parameters | ‐ | ‐ | None of the studies reported on this outcome |
| *The basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||
| GRADE Working Group grades of evidence | |||
| 11 study reported on postoperative pain on the first evening after discharge. | |||
| Topical LA compared with placebo or no treatment for reduction of postoperative pain | |||
| Participant or population: children undergoing dental extractions under general anaesthetic Settings: secondary care Intervention: topical LA Comparison: placebo or no treatment | |||
| Outcomes | Number of participants | Quality of the evidence | Comments |
| Pain or distress (self‐ or investigator‐reported pain measured postoperatively typically up to discharge)1 | 343 (4 studies) | Very low ⊕⊝⊝⊝1 | Because of substantial clinical and methodological heterogeneity in the studies, we were unable to determine an estimate of effect |
| Bleeding | 160 (2 studies) | Very low ⊕⊝⊝⊝1 | ‐ |
| Physiological parameters | ‐ | ‐ | None of the studies reported on this outcome |
| *The basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||
| GRADE Working Group grades of evidence | |||
| 1Quality of evidence assessment was downgraded for study limitations, inconsistency of effect, and imprecision. Pooling of studies was precluded by the clinical heterogeneity of the included studies in terms of analgesia (lignocaine alone (delivered as spray), bupivacaine plus adrenaline (delivered on a dental swab)), use of supplementary analgesics, and follow‐up time (see Table 6). | |||
| Local anaesthetic | Study |
| 2% lignocaine with 1:80000 adrenaline | |
| 2% lignocaine with 1:200000 adrenaline | |
| 2% lignocaine with 1:100000 adrenaline | |
| 2% lignocaine | |
| 4% lignocaine with 1:80000 adrenaline | |
| 0.5% bupivacaine with 1:200000 adrenaline | |
| 3% prilocaine 0.03 U/ml felypressin | |
| 4 mg/kg lignocaine (delivered as spray) | |
| 0.25% bupivacaine (topical) with 1:4000 adrenaline | |
| 0.25% bupivacaine (topical) with 1:200000 adrenaline |
| Pain/distress scale | Description | Recorded by | Study |
| 5‐face scale of distress | 5‐face scale ranging from no distress to very severe distress | Self‐reported | |
| 4‐category scale of distress | 4‐point scale ranging from happy to distressed | Investigator | |
| 5‐category scale of distress | 5‐point scale ranging from asleep to distressed | Investigator | |
| Faces Legs Activity Crying Consolability (FLACC) assessment tool | Aggregate score based on observation of facial expression, leg movement, activity, crying, and consolability | Investigator | |
| Modified pain/discomfort scale (MPDS) | Aggregate score based on observation of crying, movement, and agitation | Investigator | |
| Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) | Aggregate score based on observation of crying, facial expression, verbal expression pain, torso movement, child touching the "wound", and leg movement | Investigator | |
| Presence/absence of pain | ‐ | Investigator/self‐reported | |
| Simplified Toddler Preschooler‐Postoperative pain scale (STPPPS) or Toddler Preschooler‐Postoperative pain scale system (TPPPS) | Aggregate score based on observation of vocal pain expression, facial pain expression, and body pain expression | Investigator | |
| Visual analogue scale (VAS) | Self‐reporting of pain based on a line ranging from no pain to worst pain | Self‐reported | |
| Wong‐Baker FACES® Pain Rating Scale | 6‐face scale for pain intensity assessment ranging from no hurt to hurts worst | Self‐reported/Parentp‐reported | |
| 5‐face pain scale | 5‐face scale for pain intensity assessment ranging from no pain to very severe pain | Self‐reported | |
| 4‐face pain scale | 4‐face scale for pain intensity assessment ranging from 'I don't hurt at all' to 'I hurt the most' | Self‐reported | |
| CHEOPS = Children's Hospital of Eastern Ontario Pain Scale.FLACC = Faces Legs Activity Crying Consolability. | |||
| Lignocaine plus adrenaline | ||||
| Study | Outcome | Treatment | Comparator | Results |
| LA | Saline placebo | |||
| Pain (5‐face scale) waking | Mean 1.45 (1.38 sd) N = 70 | Mean 1.37 (1.32 sd) N = 69 | 0.08 (95% CI ‐0.37 to 0.53) P = 0.72 (t‐test) | |
| Pain (5‐face scale) 30 minutes postoperatively | Mean 1.74 (1.44 sd) N = 70 | Mean 1.70 (1.32 sd) N = 69 | 0.04 (95% CI ‐0.42 to 0.50) P = 0.86 (t‐test) | |
| Pain (5‐face scale) 24 hours postoperatively | Mean 0.69 (1.10 sd) N = 70 | Mean 0.75 (1.23 sd) N = 69 | ‐0.06 (95% CI ‐0.45 to 0.33) P = 0.76 (t‐test) | |
| Distress (5‐category) on waking | Mean 2.24 (0.87 sd) N = 70 | Mean 2.20 (0.85 sd) N = 69 | 0.04 (95% CI ‐0.25 to 0.33) P = 0.78 (t‐test) | |
| Distress (5‐category) 30 minutes postoperatively | Mean 2.57 (0.83 sd) N = 70 | Mean 2.42 (0.74 sd) N = 69 | 0.15 (95% CI ‐0.11 to 0.41) P = 0.26 (t‐test) | |
| Lip or cheek biting 24 hours postoperatively | 3/70 | 1/69 | P = 0.62 (Fisher's exact test) | |
| Study | Outcome | Treatment | Comparator | Results |
| LA | No treatment | |||
| Heart rate | Mean 119.53 bpm (16.50 sd) for LA. n = 24 | Mean 124.38 bpm (16.45 sd) n = 24 | ‐4.85 (95% CI ‐14.42 to 4.72) P = 0.31 (t‐test) | |
| End tidal CO2 | Mean 50.2 mm Hg (3.55 sd) n = 24 | Mean 47.46 mm Hg (4.16 sd) n = 24 | 2.74 (95% CI 0.49 to 4.99) P = 0.02 (t‐test) | |
| Respiratory rate | Mean 30.33 brpm (5.08 sd) n = 24 | Mean 32.08 brpm (5.50 sd) n = 24 | ‐1.75 (95% CI ‐4.83 to 1.33) P = 0.26 (t‐test) | |
| Pain (Wong‐Baker FACES® Pain Rating Scale, 6‐face scale) immediately postoperatively | N = 15 | N = 12 | Results not reported; authors 'did not use Wong‐Baker FACES immediately post‐operatively due to variable cooperation of subjects' | |
| Pain (Wong‐Baker FACES® Pain Rating Scale, 6‐face scale) evening following surgery | Mean 0.30 (0.21) n = 10 | Mean 0.60 (1.35) n = 10 | P = 0.92 (Wilcoxon Rank Sum test) | |
| Distress (FLACC) closest to discharge | Mean 2.47 (2.69) n = 15 | Mean 2.58 (2.54) n = 12 | P = 0.88 (Wilcoxon Rank Sum test) | |
| Lip or cheek biting evening following surgery* | 4/11 | 1/12 | P = 0.16 (Fisher's exact test) | |
| Pain (CHEOPS range 4 to 13) Assessment at 'period between when they awoke and when they were sufficiently recovered to leave for the discharge waiting area'. Exact time not specified | Median 6 (IQR 5 to 8) N = 38 | Median 6 (IQR 5 to 8.75) n = 38 | P = 0.99 (Mann Whitney U test) | |
| Bleeding (suctioning for bleeding)* | 0/38 | 5/38 | P = 0.05 (Fisher's exact test) | |
| Pain (TPPPS) 11‐minute period of observation | Mean rank 63.96 n = 50 | Mean rank 37.07 n = 50 | P < 0.0001 (Mann Whitney U Test) | |
| Bleeding (collection of 'all the aspirated fluids and used swabs')* | Mean total blood loss per root 0.79 (sd 0.06) n = 48 | Mean total blood loss per root 1.19 (sd 0.1) n = 50 | ‐0.4 (95% CI ‐0.43 to ‐0.37) P < 0.0001 (t‐test) (2 outlying values removed 6.16 and 3.96) | |
| Lignocaine alone | ||||
| Study | Outcome | Treatment | Comparator | Results |
| LA | Placebo | |||
| Postoperative pain (presence or absence) | 21/50 | 36/50 | P = 0.004 (Fisher's exact test) | |
| Maximum pulse rate during surgery | Mean 83.3 (9.6 sd) n = 50 | Mean 99.6 (14.1 sd) n = 50 | ‐16.3 (95% CI ‐21.09 to ‐11.51) P < 0.001 (t‐test) | |
| End tidal CO2 postoperative | Mean 39.8 nn Hg (3.8) n = 50 | Mean 38.8 mmHg (4.2 sd) n = 50 | 1.0 (95% CI ‐0.59 to 2.59) P = 0.21 | |
| Volume of GA (halothane) delivered | Mean 0.86% (0.28 sd) n = 50 | Mean 1.73% (0.03 sd) n = 50 | ‐0.87 (95% CI ‐0.95 to ‐0.79) P < 0.001 (t‐test) | |
| Incidence of perioperative cardiac dysrhythmias | 1/50 | 14/50 | P < 0.001 (Fisher's exact test) | |
| Prilocaine plus felypressin | ||||
| Study | Outcome | Treatment | Comparator | Results |
| LA | No treatment | |||
| Distress (4‐point scale: high score = high distress) on wakening | Median 2 (1 to 2 IQR) n = 57 | Median 3 (2 to 4 IQR) n=43 | P = 0.007 (Mann Whitney U test) | |
| Distress (4‐point scale: high score = high distress) before discharge | Median 2 (1 to 3 IQR) n = 57 | Median 2 (2 to 3 IQR) n = 43 | P = 0.03 (Mann Whitney U test) | |
| Pain (VAS) | N = 30 completed VAS (57 randomised) | N = 23 completed VAS (43 randomised) | Authors reported 'distressed children were significantly less likely to complete this method of assessment' | |
| CHEOPS = Children's Hospital of Eastern Ontario Pain Scale. | ||||
| Bupivacaine plus adrenaline | ||||
| Study | Outcome | Treatment | Comparator | Results |
| LA | No treatment | |||
| Pain (VAS 0 to 100 mm) maxilla on regaining consciousness | Median 18 (10 to 39 IQR) n = 29 | Median 29 (11 to 50 IQR) n = 29 | P = 0.33 between test and control sides P = 0.33 (Wilcoxon matched pairs signed rank) | |
| Pain (VAS 0 to 100 mm) mandible on regaining consciousness | Median 20 (5 to 45 IQR) n = 25 | Median 30 (12 to 50 IQR) n = 25 | P = 0.29 between test and control sides P = 0.29 (Wilcoxon matched pairs signed rank) | |
| Lip biting, numbness | ‐ | ‐ | "None of the patients showed signs of post‐operative soft tissue trauma following ILA." 21 children reported numbness felt on experimental side. Numbness on no‐treatment side was not reported | |
| Postoperative anxiety (Venham Picture Scale) | ‐ | ‐ | Not appropriate outcome in split mouth study | |
| Lignocaine plus adrenaline | ||||
| Study | Outcome | Treatment | Comparator | Results |
| LA | No treatment | |||
| Pain (TPPS 0 to 7): total pain score over 4 time points in the first hour after tooth extraction | Median 3 (0 to 7.5 IQR) n = 41 | Median 3 (0 to 10 IQR) n = 44 | P = 0.42 (Mann Whitney U Test) | |
| Pain (Wong‐Baker FACES Pain Rating Scale) | Summary statistics not reported | Summary statistics not reported | "There was no difference in the...pain scores in the first 4 h after returning home or on the 2 days following the extraction." n = 58 | |
| Lip or cheek biting, numbness, allergy | ‐ | ‐ | "There were no adverse events reported in this study" | |
| CI = confidence interval. | ||||
| Lignocaine plus adrenaline | |||||
| LA infiltration | LA intraligamental | No treatment | |||
| Study | Outcome | Treatment | Treatment | Comparator | Results |
| Pain/discomfort (STPPPS) immediately on waking | Median 4 (2.5 to 4.0 IQR) n = 17 | Median 4 (2.5 to 5.0 IQR) n = 19 | Median 4 (3.8 to 5.0 IQR) n = 18 | P = 0.32 (Kruskal‐Walis test) | |
| Pain/discomfort (STPPPS) 30 minutes after waking | Median 2 (0 to 4.0 IQR) n = 17 | Median 1 (0 to 3.0 IQR) n = 19 | Median 2 (0 to 3.3 IQR) n = 18 | P = 0.73 (Kruskal‐Walis test) | |
| Pain/discomfort (STPPPS) first night | Median 0 (0 to 1.0 IQR) n = 17 | Median 0 (0 to 0 IQR) n = 18 | Median 0 (0 to 0 IQR) n = 17 | P = 0.036 (Kruskal‐Walis test) | |
| Pain/discomfort (MPDS) immediately on waking | Median 4 (1.0 to 4.0 IQR) n = 17 | Median 4 (0 to 4.0 IQR) n = 19 | Median 2.5 (1.8 to 4.5 IQR) n = 18 | P = 0.96 (Kruskal‐Walis test) | |
| Pain/discomfort (MPDS) 15 minutes after waking | Median 1 (0 to 1.0 IQR) n = 17 | Median 0 (0 to 3.0 IQR) n = 19 | Median 2 (0 to 4 IQR) n = 18 | P = 0.15 (Kruskal‐Walis test) | |
| Pain/discomfort (MPDS) 30 minutes after waking | Median 0 (0 to 1.0 IQR) n = 17 | Median 0 (0 to 1 IQR) n = 19 | Median 0.5 (0 to 1 IQR) n = 18 | P = 0.49 (Kruskal‐Walis test) | |
| Postoperative anxiety (Venham Picture Test) | Median 5.0 (1.5 to 9.0 IQR) n = 17 | Median 9 (5.3 to 9.0 IQR) n = 18 | Median 7 (4.0 to 9.0 IQR) n = 17 | P = 0.23 (Kruskal‐Walis test) (The scale ranges from 0 to 8, but a score of 9 was given if the child refused to use the scale) | |
| IQR = interquartile range. | |||||
| Lignocaine alone (delivered as spray) | ||||
| Study | Outcome | Treatment | Comparator | Results |
| LA | No treatment | |||
| Pain (presence or absence) 15 minutes | 2/20 | 15/20 | P < 0.001 (Fisher's exact test) | |
| Pain (presence or absence) 30 minutes | 1/20 | 11/20 | P < 0.001 (Fisher's exact test) | |
| Pain (presence or absence) 60 minutes | 2/20 | 9/20 | P = 0.03 (Fisher's exact test) | |
| Bleeding | ‐ | ‐ | "There was no early postoperative adverse effects in all groups except for a greater incidence of prolonged postoperative blood oozing in the group C [no treatment] associated with crying." No summary statistics reported | |
| Bupivacaine plus adrenaline (delivered on a dental swab) | ||||
| Study | Outcome | Treatment | Comparator | Results |
| LA | Placebo | |||
| Pain (4‐category scale) 15 minutes postoperatively | Median 1.5 (1 to 2 IQR) n = 58 | Median 1 (1 to 3 IQR) n = 62 | P = 0.66 (Mann Whitney U Test) | |
| Pain (4‐category scale) 30 minutes postoperatively | Median 1 (0 to 2 IQR) n = 58 | Median 1 (0 to 2 IQR) n = 62 | P = 0.46 (Mann Whitney U Test) | |
| Bleeding at 15 and 30 minutes | ‐ | ‐ | "There was no difference in degree of bleeding between the groups. The average of the nurse's subjective assessment of bleeding was 'mild' in both groups at 15 min and 'none' at 30 min" | |
| Distress (5‐category faces scale) postoperatively | Mean 1.28 (1.31 sd) n = 68 | Mean 1.56 (1.20 sd) n = 67 | ‐0.28 (95% CI ‐0.71 to 0.15) P = 0.19 (t‐Test) | |
| Distress (5‐category faces scale) 15 minutes postoperatively | Mean 1.90 (1.49 sd) n = 68 | Mean 1.96 (1.33 sd) n = 67 | ‐0.06 (95% CI ‐0.54 to 0.42) P = 0.81 (t‐Test) | |
| Pain (TPPPS) 5 minutes postoperatively | Median 0 (0 to 7 Range) n = 24 | Median 0 (0 to 7 Range) n = 24 | "There was no significant difference in the individual maximum pain scores between the two groups (Mann Whitney U Test P > 0.05)" | |
| Pain (TPPPS) 10 minutes postoperatively | Median 1 (0 to 8 Range) n = 24 | Median 0 (0 to 7 Range) n = 24 | ‐ | |
| Pain (TPPPS) 15minutes postoperatively | Median 0 (0 to 7 Range) n = 24 | Median 0 (0 to 7 Range) n = 24 | ‐ | |
| Pain (TPPPS) 30 minutes postoperatively | Median 1 (0 to 7 Range) n = 24 | Median 0 (0 to 5 Range) n = 24 | ‐ | |
| Pain (TPPPS) combined over all 4 time points | Median 1.5 (0 to 29 Range) n = 24 | Median 1 (0 to 25 Range) n = 24 | "…no significant difference between the two groups (P > 0.05)" | |
| CI = confidence interval. | ||||
