Continuous infusion of local anesthetic at iliac crest bone-graft sites for postoperative pain relief - A randomized, double-blind study

Mental Health Center of Denver, Denver, Colorado, United States
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 01/2007; 88(12):2606-12. DOI: 10.2106/JBJS.E.00984
Source: PubMed


Autologous bone graft is the so-called gold standard for reconstruction of bone defects and nonunions. The most frequent complication is donor site pain. The iliac crest is a common source for autologous bone graft. The purpose of this study was to determine whether a continuous infusion of 0.5% bupivacaine into the iliac crest harvest site provides pain relief that is superior to the relief provided by systemic narcotic pain medication alone in patients undergoing reconstructive orthopaedic trauma procedures.
A prospective, double-blind randomized study of patients over eighteen years of age who were undergoing harvesting of iliac crest bone graft was conducted. The patients were randomized to the treatment arm (bupivacaine infusion pump) or the placebo arm. Postoperatively, all study patients received morphine sulfate with use of a patient-controlled analgesia pump. The patients recorded the pain at the donor and recipient sites with use of a scale ranging from 0 to 10. The use of systemic narcotic medication was recorded. Independent-samples t tests were used to assess differences in perceived pain relief between the treatment and control groups at zero, eight, sixteen, twenty-four, thirty-two, forty, and forty-eight hours after surgery. Pain was also assessed at two and six weeks postoperatively.
Sixty patients were enrolled. Across all data points, except pain at the recipient site at twenty-four hours, no significant differences in the perception of pain were found between the bupivacaine group and the placebo group. On the average, patients in the treatment group reported more pain than those in the control group. No significant difference was found between the two groups with regard to the amount of narcotic medication used.
No difference in perceived pain was found between the groups. The results of this small, unstratified study indicate that continuous infusion of bupivacaine at iliac crest bone-graft sites during the postoperative period is not an effective pain-control measure in hospitalized patients receiving systemic narcotic medication.

5 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: In order to compare the effects of the two repair techniques, a controlled study was devised in which the right sciatic nerve of Sprague-Dawley rats was surgically cut and reanastomosed by means of either four epineurial sutures or two epineurial sutures and CO2 laser welds. After a mean of 11 months, both sciatic nerves were excised. The conduction velocities recorded for suture- and laser-assist-repaired nerves were not found to be significantly different. However, laser-repaired nerves exhibited lower conduction failure rates and lower stimulation thresholds than nerves with conventional suture repair. No apparent difference in the diameter of myelinated fibers distal to the anastomosis in either of the two repair categories was observed. Sutured nerves exhibited greater branching of myelinated axons proximal to the anastomosis and at the same time permitted fewer axons through the anastomosis as compared to laser-repaired nerves. It is suggested that this could explained the greater incidence of neuroma formation in sutured nerves as well as the diminished conduction
  • [Show abstract] [Hide abstract]
    ABSTRACT: Point-source reconstruction arises as an important problem in many applications of nuclear instrumentation. Our main concern is PET image reconstruction for oncology in order to improve the detection of hyperfixation point source as metastasis or to reconstruct an object from a fewer number of measures. The issue is to reach detectability of small objects from noisy data. We propose to perform a statistical reconstruction method, based on the maximum entropy on the mean principle. This method is particularly relevant to solve strongly ill-posed problems. Taking into account statistical data distribution and prior knowledge, it is able to detect small objects from noisy data, which may be angularly or spatially undersampled. As opposed to classical regularisation methods for reconstruction, this method does not imply any spatial smoothing operation. We illustrate the method on simulated noisy angularly undersampled acquisitions
    Nuclear Science Symposium, 1998. Conference Record. 1998 IEEE; 02/1998
  • Le Praticien en Anesthésie Réanimation 06/2008; 12(3). DOI:10.1016/j.pratan.2008.04.001
Show more