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.

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    • "There have been reports in other fields of continuous local anesthetic infusion, via postoperative pain pump, directly into the anterior iliac crest donor site (Morgan et al., 2006; Singh et al., 2007). Bupivacaine hydrochloride, the most commonly used anesthetic for this purpose, is a long-acting local anesthetic that is widely used for both intraoperative and postoperative analgesia. "
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