REDUCTION IN MORBIDITY AFTER ILIAC CREST BONE HARVESTING - THE CONCEPT OF PREEMPTIVE ANALGESIA

The technique of autologous iliac crest bone grafting is an important aspect in the treatment of patients with cleft lip, cleft palate, and other craniofacial disorders. In patients with cleft lip and palate, t he alveolar bone graft creates a continuous maxillary arch, closes the oronasal fistula, provides bony support for facial soft tissue and te eth, and facilitates orthodontic movement of teeth. The anatomic and p hysiologic benefits of this and similar autologous bone graft procedur es are apparent. However, pain at the donor site represents a signific ant source of postoperative morbidity. This study was conducted to eva luate postoperative pain and the ability to perform activities of dail y living after bupivacaine infiltration to iliac crest donor sites. Th irty-four alveolar bone graft patients (18 females, 16 males) treated at two teaching hospitals were included in the study. Eleven of the pa tients received intraoperative bupivacaine at the iliac donor site and 23 did not. A questionnaire was returned by all participants, and tel ephone follow-up was obtained. Responses to postoperative pain, time p eriod to ambulation, and ability to perform activities of daily living were evaluated. Patients who received postoperative bupivacaine exper ienced delayed onset of postoperative pain, earlier ambulation, and we re able to return to normal daily activity in a shorter period of time than those patients who received no local anesthesia. The concept of preemptive analgesia and its application to craniofacial surgery is di scussed.