Bupivacaine Administration and Postoperative Pain following Anterior Iliac Crest Bone Graft for Alveolar Cleft Repair

2009 ◽  
Vol 46 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Jason E. Dashow ◽  
Charlotte W. Lewis ◽  
Richard A. Hopper ◽  
Joseph S. Gruss ◽  
Mark A. Egbert
Keyword(s):  
Postoperative Pain ◽  
Pain Score ◽  
Cleft Lip ◽  
Iliac Crest ◽  
Alveolar Bone ◽  
Donor Site ◽  
Pain Medication ◽  
Iliac Crest Bone Graft ◽  
Postoperative Pain Score ◽  
Alveolar Bone Grafting

Objective: To determine whether placement of a bupivacaine-soaked absorbable sponge (BAS) in addition to bupivacaine infiltration at the anterior iliac crest (AIC) donor site alters postoperative pain for children undergoing alveolar bone grafting (ABG) for cleft lip with or without cleft palate (CL±P). The comparison group received only bupivacaine infiltration (NO BAS) at the AIC. Design: Retrospective cohort. Medical records were abstracted by one investigator, blinded to BAS versus NO BAS use. Setting and Patients: Consecutive patients with CL±P who underwent ABG between 2000 and 2006 at one large U.S. craniofacial center. Intervention: BAS was used in 118 procedures and NO BAS in 89. Outcome Measures: Postoperative pain score, total and opioid pain medication requirement, length of hospital stay (LOS), and time to initial ambulation. Results: One hundred eighty-two patients underwent 207 ABG procedures. Mean pain scores were significantly lower when BAS was used compared with NO BAS (1.3 versus 1.8; p  =  .01). Patients who received BAS required significantly less pain medication than NO BAS patients: opioids (0.14 versus 0.20 mg/kg; p  =  .01) and total (0.60 versus 0.71 mg/kg; p  =  .02). Relative to the NO BAS group, those who received BAS had a shorter LOS (30.9 versus 42.4 hours; p < .0001) and less time to initial ambulation following surgery (14.4 versus 20.6 hours; p < .0001). Conclusion: Use of BAS at the AIC donor site significantly reduced postoperative pain score, pain medication requirement, LOS, and time to ambulation relative to children who did not receive BAS following ABG.

A Comparison of Shepard's Osteotome versus Trapdoor Flap Technique to Harvest Iliac Crest Bone for Secondary Alveolar Bone Grafting

2008 ◽  
Vol 45 (4) ◽  
pp. 347-352 ◽  
Author(s):  
J. Constantinides ◽  
P. Chhabra ◽  
P. J. Turner ◽  
B. Richard
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Alveolar Bone ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Iliac Crest Bone Graft ◽  
Open Technique ◽  
Flap Technique ◽  
Graft Harvest ◽  
Alveolar Bone Grafting

Objective: To compare the postoperative donor site morbidity and alveolar bone graft results following two different techniques for iliac crest bone graft harvest: a closed (Shepard's osteotome) and an open (trapdoor flap) technique. Design: A retrospective review of two cohorts of alveolar bone grafts performed from 1998 to 2004 in Birmingham Children's Hospital by two surgeons using different harvest techniques. Medical and nursing anesthetic notes and medication charts were reviewed. Alveolar bone graft results were assessed using preoperative and postoperative radiographic studies. Patients: A total of 137 patients underwent an operation. Of these, 109 patients were compatible with the inclusion criteria (data available, first operation, no multiple comorbidities). Sixty-four patients had iliac bone harvested using the open trapdoor technique, while 45 had the same procedure using the closed osteotomy technique. Results: Maximum bone graft volumes harvested were similar with both techniques. The mean length of hospital stay was 50.9 hours for the osteotome and 75.5 hours for the open technique group (p < .0001). The postoperative analgesia requirement was higher and the postoperative mobilization was delayed and more difficult for the open technique patients (p < .0005). Kindelan scores performed by two independent orthodontists were similar for both techniques. Conclusion: The findings demonstrate that harvesting bone from the iliac crest using an osteotome technique reduces time in hospital, analgesia requirements, and postoperative donor site morbidity with no detrimental outcome.

Iliac Crest Donor Site for Children With Cleft Lip and Palate Undergoing Alveolar Bone Grafting

2016 ◽  
Vol 27 (3) ◽  
pp. 598-601 ◽  
Author(s):  
Jonathan Wheeler ◽  
Megan Sanders ◽  
Stanley Loo ◽  
Zac Moaveni ◽  
Glenn Bartlett ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Cleft Lip ◽  
Iliac Crest ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Donor Site ◽  
Alveolar Bone Grafting

Alveolar Bone Grafting: Donor Site Review of 100 Consecutive Cases in Cleft Lip and Palate

2017 ◽  
Vol 54 (2) ◽  
pp. 137-141 ◽  
Author(s):  
Kavit Amin ◽  
Wee Sim Khor ◽  
Anais Rosich-Medina ◽  
Victoria Beale
Keyword(s):  
Bone Grafting ◽  
Cleft Lip ◽  
Iliac Crest ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Donor Site ◽  
Oral Morphine ◽  
Unknown Origin ◽  
Pyrexia Of Unknown Origin ◽  
Alveolar Bone Grafting

Objective Review of patients who underwent secondary alveolar bone grafting for total inpatient stay, postoperative complications, and postoperative analgesic requirements. Design Retrospective analysis of medical records. Setting Tertiary care center as part of a regional cleft lip and palate network. Patients All patients who underwent secondary alveolar bone grafting from the iliac crest. Interventions Local anesthetic was infiltrated overlying the anterior iliac crest. An incision was made to conform to the future skin crease and avoid muscle dissection. The cartilaginous cap was incised and raised, and cancellous bone was then harvested. The cavity was packed with hemostatic cellulose and closed in layers. All patients received postoperative antibiotics. All patients were prescribed regular paracetamol (acetaminophen) and ibuprofen if there were no contraindications. Oral morphine was available when requested. Main Outcome Measures Length of stay, postoperative analgesic requirements, and postoperative donor site and oral complications. Results From 100 consecutive patients, 92 (92%) of the patients were discharged the day after surgery; one (1%) patient required four nights of monitoring for postoperative pyrexia of unknown origin. All patients received regular paracetamol, and the majority (86%) did not require oral morphine. Complications included seroma (4%), superficial donor site abscess (1%), postoperative pyrexia of unknown origin (2%), gingival bleeding (2%), and oral infection (2%). Conclusion The findings suggest that donor site pain may be well controlled with simple, regular analgesia. Children tolerated this procedure well and were safely discharged the day after surgery. Alveolar bone grafting from the iliac crest was found to have low complication rates.

Evaluation of Alveolar Bone Grafting: A Survey of ACPA Teams

2005 ◽  
Vol 42 (1) ◽  
pp. 99-101 ◽  
Author(s):  
Ananth S. Murthy ◽  
James A. Lehman
Keyword(s):  
North America ◽  
Cleft Palate ◽  
Bone Grafting ◽  
Iliac Crest ◽  
Alveolar Bone ◽  
Donor Site ◽  
X Rays ◽  
Alveolar Bone Grafting ◽  
Missing Tooth

Objective To evaluate the management of alveolar clefts by cleft palate and craniofacial teams in North America. Design An anonymous survey was mailed to 240 American Cleft Palate– Craniofacial Association teams across North America regarding alveolar bone grafting. The questionnaire included multiple questions about each team's approach to alveolar bone grafting and options for the missing tooth. Results Consensus was achieved in three areas: 90% of centers performed secondary alveolar bone grafting, 78% performed grafting between ages 6 and 9 years, and iliac crest donor site was the most popular site (83%). There was no consensus with respect to dental criteria for the timing of grafting, follow-up x-rays, or the use of a grading system for evaluating results. In addition, there was no consensus on the management of the missing tooth. Conclusion There is wide acceptance of secondary bone grafting and there is a consensus for the age of grafting (6 to 9 years) and donor site (iliac crest). The disturbing finding was the lack of postoperative x-ray evaluation of the results. With so much variability in management, the use of a routine, standardized scale to measure postoperative results would allow for better outcome studies in alveolar bone grafting.

scholarly journals Examining the Safety and Efficacy of Supplemental Regional Anesthesia After Iliac Crest Harvest During Cleft Alveolar Bone Grafting

FACE ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 66-69
Author(s):  
Robert Lesko ◽  
Srinivas M. Susarla ◽  
Denver Lough ◽  
Anand R. Kumar
Keyword(s):  
Bone Graft ◽  
Pain Score ◽  
Regional Anesthesia ◽  
Iliac Crest ◽  
Alveolar Bone ◽  
Iliac Crest Bone Graft ◽  
Minimal Access ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: The optimal prevention and treatment of pain associated of iliac crest bone graft donor sites for the treatment of cleft alveolus defects has not been well characterized. The aim of this study is to assess the efficacy of minimal access bone graft techniques with or without regional anesthesia in iliac crest bone harvest and compare to outcomes to traditional open harvest techniques. Methods: A retrospective review of 46 patients undergoing iliac crest bone harvest using traditional open iliac crest bone graft (ICBG) alone (Group 1, n = 20), minimal access ICBG (Group 2, n = 20), or minimal access ICBG with paravertebral anesthetic block (Group 3, n = 5) was performed. Post operative pain scores, narcotic consumption, and hospital stay were analyzed. Results: The average time to first narcotic was 247 minutes in Group 1, 193 in Group 2, and 1162 minutes in Group 3 ( P < .0002). Total narcotic use was 0.117 mg/kg in Group 1, 0.131 mg/kg in Group 2, and 0.072 mg/kg in Group 3. The average pain score (VAS) was 2.96 in Group 1, 1.83 in Group 2, and 1.08 in Group 3 ( P < .01). The average length of stay was 1.45 for Group 1, 1.36 for Group 2, and 1.0 for Group 3. Bone graft extrusion occurred in 6 patients (27.3%) in Group 1 and none in Group 2 or 3. There were no wound infections, bleeding requiring reoperation, or mortalities. Conclusion: The addition of regional anesthesia to minimal access alveolar bone graft harvest significantly reduces time to first narcotic use. Although not significant, a strong trend was found with regional anesthesia to lower the pain score (VAS) and total narcotic use. Regional anesthesia did not significantly reduce the length of hospital stay compared to either group. Minimal access techniques with supplemental regional anesthesia significantly lowered the pain score and time to first narcotic and trended to decreased length of hospitalization and total narcotic use compared to traditional open techniques.

Suitability of the Iliac Crest as a Site for Harvest of Autogenous Bone Grafts

1993 ◽  
Vol 30 (6) ◽  
pp. 579-581 ◽  
Author(s):  
John W. Canady ◽  
Deborah P. Zeitler ◽  
Sue Ann Thompson ◽  
Chris D. Nicholas
Keyword(s):  
Cancellous Bone ◽  
Postoperative Morbidity ◽  
Iliac Crest ◽  
Alveolar Bone ◽  
Donor Site ◽  
Bone Grafts ◽  
Autogenous Bone ◽  
Alveolar Bone Grafting ◽  
Patient Reported

Many donor sites have been advocated for obtaining cancellous bone to be used for grafting alveolar defects. Recently, some authors have suggested that the iliac crest site produced an unacceptably high degree of postoperative morbidity. Because of this morbidity, the use of other donor areas, e.g., rib, cranium, and mandible, are advocated. The iliac crest donor site for alveolar bone grafting has been common practice in our Institution for years under the assumption that little or no postoperative morbidity occurred. To investigate and document the accuracy of our assumption, the charts of the most recent 50 consecutive patients receiving alveolar bone grafts, all of which used the iliac crest as a donor site, were reviewed. Postoperative pain, numbness, infection, paralysis, or long-term disability were catalogued from the charts. In addition, a questionnaire was sent to the parents and patients requesting their perceptions of these parameters. In the cases reviewed, the average length of skin incision was 4.2 cm. The average quantity of bone harvested was 4.1 cc. The usual hospitalization time was 2–3 days. No patients experienced serious or long-term complications at the surgical donor site. Immediate postoperative complications among the 50 patients studied were limited to one hematoma, one stitch abscess, one case of swelling with pain, one erythema, and one 4-day fever accompanied by slight serosanguineous drainage. Information from the questionnaire suggests that most patients returned to full activity within 4–6 weeks. No patient reported any long-term pain or disability. We conclude that the iliac crest is a suitable site to harvest cancellous bone for use in alveolar defect grafting, and should not be rejected solely because of concerns regarding excessive morbidity.

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