Pain Relief at the Bone Graft SiteBone graft is often needed during orthopedic surgery. Bone removed from one site and grafted to another in the same patient is called autologous. Autologous bone graft is a good option for reconstruction of bone defects and breaks that don't heal.
The iliac crest is the most commonly used site of donor bone. This is the boney bump felt in front of the hip. It's easy accessibility makes it a good choice. The down side is the possible side effects. Pain at the donor site is the most common problem.
Reducing postoperative pain helps give patients a faster recovery time. In this study, researchers try using a continuous local anesthetic at the donor site to manage pain. Two groups of patients are compared.
All patients received systemic medications for pain control. The morphine-based drug was delivered through a self-controlled pain pump. Everyone also had an infusion pump placed directly into the wound. This device was put in place during the operation as the wound was closed.
Delivery of a local anesthetic like novacaine called bupivacaine was used in Group 1. Group 2 (placebo group) received infusion of a saline solution to the donor site.
All patients kept track of pain levels at the donor site and at the graft site. Pain levels were recorded every eight hours for 48 hours. The amount of pain medication used was also measured.
The authors report no benefit from the use of the local anesthetic infusion at the donor site. In fact, the treatment group had more pain than the control group. The treatment group also used more pain medication than the control group.
There was no difference in pain levels reported at the recipient graft site. This was true no matter where the recipient site was located (for example, ankle, arm, collarbone, foot).
The authors suggest the morphine-based narcotic given was the reason there was no difference between groups. In other words, both groups benefitted equally from the systemic pain relievers. There was no added value from the additional local infusion pump.
Steven J. Morgan, MD, et al. Continuous Infusion of Local Anesthetic at Iliac Crest Bone-Graft Sites for Postoperative Pain Relief. In The Journal of Bone and Joint Surgery. December 2006. Vol. 88-A. No. 12. Pp. 2606-2612.
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