Double-blind, randomized, controlled trial of local anesthetic use for iliac crest donor site pain

Autogenous iliac crest bone grafts are often used for persons undergoing anterior cervical fusion (ACF). Study findings have shown that pain at the iliac crest donor site can often be more severe than that at the primary operation site. A method used to eliminate pain after bone harvesting involves infiltration of a local anesthetic directly into the site. This study examined the efficacy of local anesthetic infiltration in the control of donor site pain, utilizing a randomized, double-blind, placebo-conrolled design. All participants received standard postoperative intravenous and oral analgesic. Those in the study group also received six injections of bupivacaine hydrochloride 0.25% into the donor site, while participants in the placebo group received normal saline injections. Participants receiving bupivacaine (n = 14) consistently reported lower hip pain scores than participants receiving the placebo (n = 8), with significant differences noted 3 hours after the first and second doses of the study drug. The bupivacaine group's mean morphine intake for the first 24 hours after surgery was found to be lower (32 mg; placebo 44 mg), whereas participants younger than 49 years who received bupivacaine were found, on average, to have stayed in the hospital one day less (3.6 days) than placebo group participants (4.5 days). Younger participants receiving bupivacaine required less morphine and had, on average, a reduced length of stay. The clinical implication of using local anesthetic for the relief of donor site pain suggests that it is a safe and efficacious technique.