Summary of findings 3. Infiltration injection LA versus intraligamental injection LA versus no treatment.

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 (studies)	Quality of the evidence (GRADE)	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). CI: confidence interval; LA: local anaesthetic; RR: risk ratio.
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.

¹1 study reported on postoperative pain on the first evening after discharge.
 ²Quality of evidence assessment was downgraded for study limitations, inconsistency of effect, and imprecision. Single study of lignocaine plus adrenaline LA (see Table 9).