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

Abstract

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.