The Journal of Bone and Joint Surgery (American). 2006;88:2606-2612.
doi:10.2106/JBJS.E.00984
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Continuous Infusion of Local Anesthetic at Iliac Crest Bone-Graft Sites for Postoperative Pain Relief

A Randomized, Double-Blind Study

Steven J. Morgan, MD1, Kyle J. Jeray, MD2, Laurel H. Saliman, MD3, Howard J. Miller, MD1, Allison E. Williams, ND, PhD1, Stephanie L. Tanner, MS2, Wade R. Smith, MD1 and J. Scott Broderick, MD2

1 Denver Health Medical Center, 777 Bannock Street, MC 0188 (S.J.M., A.E.W., and W.R.S.) or MC 0218 (H.J.M.), Denver, CO 80204. E-mail address for S.J. Morgan: steven.morgan{at}dhha.org. E-mail address for H.J. Miller: Howard.miller{at}dhha.org. E-mail address for A.E. Williams: allison.williams{at}dhha.org. E-mail address for W.R. Smith: wade.smith{at}dhha.org
2 Orthopaedic Surgery Education, Greenville Hospital System, 701 Grove Road, 2nd Floor ERC Support Tower, Greenville, SC 29605. E-mail address for K.J. Jeray: kjeray{at}ghs.org. E-mail address for S.L. Tanner: stanner{at}ghs.org. E-mail address for J.S. Broderick: sbroderick{at}ghs.org
3 Swedish Pediatric Specialty Care, 1101 Madison Street #510, Seattle, WA 98104. E-mail address: laurel.saliman{at}swedish.org

Investigation performed at Denver Health Medical Center, Denver, Colorado, and Greenville Hospital System, Greenville, South Carolina

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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 procedures.

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 medication used.

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.


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Letters to the Editor:

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Continuous Infusion of Local Anesthetic at Iliac Crest Bone-Graft Sites
Stephan Blumenthal, M.D., et al.
JBJS Online, 4 Jan 2007 [Full text]
Dr. Jeray et al. respond to Dr. Blumenthal
Kyle J. Jeray, M.D., et al.
JBJS Online, 4 Jan 2007 [Full text]