Background: 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
Methods: 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.
Results: 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
Conclusions: 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.
Level of Evidence: Therapeutic Level I. See Instructions
to Authors for a complete description of levels of evidence.