Intraoperative Liposomal Bupivacaine for Donor Site Iliac Crest Bone Harvest in Alveolar Bone Grafting
Ronak A. Patel, BS, Eric M. Jablonka, MD, Mimi R. Borrelli, MBBS MSc, Rohit K. Khosla, MD, Hermann Peter Lorenz, MD, Arash Momeni, MD, Derrick C. Wan, MD.
Stanford University, Stanford, CA, USA.
PURPOSE: Iliac crest bone harvesting is routinely performed for patients undergoing alveolar bone grafting. Postoperative pain is one of the most common sources of graft site morbidity. Liposomal bupivacaine has been shown to decrease postoperative pain in patients receiving bunionectomy of hemorrhoidectomy. The role in pediatric patients undergoing alveolar bone grafting with an iliac crest donor site is unknown. The purpose of this study is to evaluate the efficacy of liposomal bupivacaine as compared to bupivacaine at the iliac crest hip donor site in pediatric patients.
METHODS: 38 patients undergoing iliac crest bone grafting were included in the study, with 21 and 17 patients receiving 0.25% bupivacaine and 1.30% liposomal bupivacaine respectively. Inclusion criteria included patients less than or equal to 18 years old. Outcomes of interest included reported pain scores every 4 hours for the first 24 hours, cumulative narcotic use, and length of stay. Postoperative steps were monitored using an activity tracker.
RESULTS: The bupivacaine and liposomal bupivacaine groups showed no significant differences in age, weight, distribution of clefts, choice of donor hip, or length of stay. Pain scores were significantly improved at the 4-, 12-, 16-, 20-, and 24-hour time points (p < 0.001, p = 0.010, p = 0.002, p = 0.006, and p = 0.009), with the 8-hour time point approaching significance (p = 0.064) in the liposomal bupivacaine group versus the bupivacaine group (Figure 1A). Total narcotic consumption was reduced in the liposomal bupivacaine group at 4.65 ± 5.26 oral morphine equivalents compared to the bupivacaine group at 14.29 ± 11.97 (p = 0.002). Average steps on postoperative day 1, 2, 3, and 5 were significantly higher in the liposomal bupivacaine group (p <0.001, p <0.001, p <0.001, p = 0.032), with day 4 approaching significance (p = 0.056) (Figure 1B).
CONCLUSION: Liposomal bupivacaine reduces postoperative pain in children undergoing iliac crest bone graft harvest, and this is reflected in a reduction in narcotic use as well as an improvement in early activity.
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