Continuous infusion of local anesthetic at iliac crest bone-graft sites for postoperative pain relief - A randomized, double-blind study
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.
Available from: cpcjournal.org
- "The use of bupivacaine hydrochloride for postoperative pain relief has been demonstrated in several other surgical procedures with mixed results. Morgan et al. (2006) showed no advantage for those patients undergoing bone grafting for orthopedic trauma injuries. Conversely, Singh et al. (2007) showed a 70% reduction in the incidence of chronic iliac crest dysesthesias through the use of continuous marcaine infusion catheters following iliac crest bone graft harvest for spinal arthrodesis. "
[Show abstract] [Hide abstract]
ABSTRACT: This is a review of modifications made to the classic technique for harvesting bone graft from the iliac crest. Prior techniques for harvesting iliac bone often resulted in significant postoperative pain, disability, and a cosmetically unacceptable scar and contour deformity.
A retrospective review of patients who underwent bone graft harvest over a 7-year period was done.
The modifications described use a skin incision medial to the anterior superior iliac crest. The medial aspect of the iliac crest is elevated along the midsagittal axis of the crest. The medial cap is reflected outward, exposing cancellous bone.
A review of 51 patients demonstrated only two minor self-limiting complications.
This procedure provides an abundant supply of both cortical and cancellous bone, an aesthetically acceptable scar, and decreased patient discomfort.
The Cleft Palate-Craniofacial Journal 10/1999; 36(5):388-90. DOI:10.1597/1545-1569(1999)036<0388:HIBGDT>2.3.CO;2 · 1.20 Impact Factor
[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
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.