Summary of findings 4. Topical LA versus no treatment or placebo.

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 (studies)	Quality of the evidence (GRADE)	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). 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.

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 10).