Pain following iliac crest bone grafting of alveolar clefts

The purpose of this study was to investigate pain following iliac crest bone grafting of alveolar clefts. The study involved 34 consecutive patients requiring secondary alveolar bone grafting. The study population consisted of 21 males and 13 females with a mean age of 11 years (SD = 3.4). Twenty-three patients had unilateral and 11 patients bilateral clefts. The patients were treated in a like manner with harvesting of an iliac crest cortico-cancellous block concurrently with the raising of flaps and cleft closure. All surgery was performed by combinations of the authors. Eighteen patients were placed on postoperative intravenous ketorolac and the remainder were not. All patients received patient controlled analgesia at a dose of 0.015 mg/kg of morphine with an 8 min exclusion period before re-dosing. Total narcotic usage averaged 0.18 mg/kg (SD = 0.19) with 31 patients using less than 0.4 mg/kg. Regular ketorolac did not influence narcotic usage, nor did sex, age or nature of the cleft. Thirty-one patients began ambulating on the first postoperative day and 27 were discharged within 2 days of surgery. No long-term donor site morbidity was observed. Our results suggest that pain following iliac crest bone grafting of alveolar clefts is not severe and is readily alleviated with small quantities of analgesic drugs. It would appear that short-term morbidity following these procedures is frequently overstated and is in itself not a valid reason to change to calvarial or mandibular donor sites.