Physiological Changes in the Patients Undergoing Third Molar Surgery Under Local Anesthesia - A Prospective Pilot Study

Abstract

Purpose: The purpose of this study was to assess the physiological changes associated with stress in patients undergoing third molar surgery under local anesthesia. Despite adequate anaesthetic administration, patients often experience significant emotional stress.  Hence, this study aims to evaluate the effect of stress on the physiological parameters during the surgical procedure.

Materials and Methods: It was a pilot study conducted in the department of oral and maxillofacial surgery, in the Saveetha Dental College & Hospital, Chennai. The healthy ASA I adult patients, aged more than 18 years, having mesioangular impacted mandibular third molar (MIMM), level 1, class A were included in this study. Patients taking analgesics within 72 hours and active pericoronitis have been excluded from the study.  A standardized surgical protocol was followed, including a single experienced surgeon performing all extractions using a modified ward’s incision, bone guttering, and planned tooth sectioning if necessary. Patient physiological parameters like blood pressure, heart rate, oxygen saturation, pulse rate along with pain perception using VAS score, were recorded at baseline, stimulation, and recovery phases. To validate the physiological changes, a comparative analysis between objective physiological data and subjective pain scores was conducted using IBM SPSS version 23 to assess the accuracy and sensitivity of the novel method.

Results: Systolic blood pressure showed a gradual increase from preoperative to 90 minutes postoperative, and Diastolic blood pressure slightly decreased up to 60 minutes and returned to near baseline at 90 minutes. However, neither of these changes was statistically significant. Respiratory rate remained comparable throughout the observation period with no significant variation (P = 0.12). Oxygen saturation (SpO₂) levels gradually increased over time, with a statistically significant difference (P = 0.005; post hoc P = 0.031). Pain scores, measured using the Visual Analog Scale (VAS), progressively decreased from preoperative to 90 minutes postoperative. These reductions in pain scores were statistically significant at multiple intervals, including between preoperative and 30 minutes (P = 0.001), 60 and 90 minutes (P = 0.019), 60 and 90 minutes (P = 0.019), and preoperative to 90 minutes (P = 0.001).

Conclusion: These findings suggest that the stress related to third molar surgery may influence subjective pain perception, like the VAS score. However, their impact on objective physiological parameters like blood pressure, heart rate, oxygen saturation, and pulse rate was minimal.