Pain in the Bone Controlled at Home: Nerve Block Versus Pain Pump in Alveolar Bone Grafting

Pain after the alveolar bone graft (ABG) procedure can be difficult to manage. The goal of this study is to assess the described outpatient ABG protocol by comparing outcomes between pain catheters and local nerve blocks.

A retrospective single-institution review was conducted on patients with autologous iliac crest bone grafts (ICBGs). At the donor site, patients either receive on-Q continuous ropivacaine pain catheters or a local nerve block. Various outcomes such as postoperative pain medications used, postoperative pain scores, length of stay (LOS), and complications were compared between the 2 groups.

Of the 79 patients that met our inclusion criteria, 60 (75.9%) received pain catheters and 19 (24.1%) received nerve blocks. Postoperative use of opioids and nonopioid medications such as acetaminophen and ibuprofen was similar between the 2 groups. The nerve block group reported a lower median pain score postoperatively than patients who received a pain catheter (5.0 versus 1.0, P =0.008). The overall complication rate was 2 (3.3%) for the pain catheter group due to pump failure and zero for the nerve block group.

Pain catheters and local nerve blocks are both safe methods of local anesthesia with low complication rates. However, pain catheters create concern for leakage or pump failure and a higher burden of care for patients and families. In addition, patients with nerve blocks report lower pain scores. As such, we have gradually shifted our practice toward the use of nerve blocks for an improved patient experience.