Periodic Bupivacaine Delivery Through Catheter at Iliac Bone Graft Donor Site: Safely Reducing Donor Site Morbidity

Iliac bone grafting is used for autologous reconstruction of bone defects. Donor site pain can be greater than any morbidity related to iliac crest bone graft harvesting, and it is a significant factor in delaying early recovery and rehabilitation. Single-shot or postoperative continuous infusion of local anesthetics through catheters has been described in the literature. We aimed to demonstrate the effectiveness of "postoperative periodic delivery of bupivacaine through a catheter at iliac bone graft donor site" in reducing postoperative pain and facilitating patient mobilization. Seventy-one patients who underwent alveolar bone grafting using iliac crest bone graft were evaluated. These patients were divided into 2 groups, including 36 in the catheter group and 35 in the control group. Patients in the catheter group received 0.3 mg/kg bupivacaine, diluted 1:1 with normal saline through the catheter, administered 4 times daily during the first 36 hours. All patients received standardized systemic analgesia consisting of intravenous paracetamol at a dose of 15 mg/kg every 8 hours and, if additional analgesia was required, intravenous tramadol at a dose of 1 mg/kg. Postoperative pain was assessed using the Burford Pain Thermometer, and all patients were followed for mobilization and complications related to local anesthetic toxicity, the catheter, and the donor site. Patients from the catheter group reported relatively lower levels of postoperative pain as compared with participants in the control group. The total postoperative intravenous tramadol requirement was significantly lower in the catheter group. Moreover, time to first postoperative mobilization was significantly shorter in the catheter group. Periodic catheter delivery of bupivacaine seems to be an effective, safe, easy-to-apply, and well-tolerated technique. LEVEL OF EVIDENCE: Level IV.