Reduction in Morbidity After Iliac Crest Bone Harvesting

Hoard, Martin A.; Bill, Timothy J.; Campbell, Robert L.

doi:10.1097/00001665-199809000-00011

Cited by 39 publications

(32 citation statements)

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“…Posterolateral intertransverse process fusion is a commonly performed procedure in the lumbar spine; however, the incidence of failure to achieve fusion has ranged from 5% to 45% in large series because of inadequate new bone mass caused by the limited mass of graft bone or poor surgical technique 5,10,41,46) . Although autogenous bone graft is the gold Standard for spinal fusion, there is a limit to its mass and complications are associated with bone harvest in as many as 20% of the patients, even in the hands of experienced surgeons 8,19,20,37,38) . In recent years, a variety of materials have been developed as alternatives to autogenous bone graft to avoid their disadvantages.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Risedronate on Posterior Lateral Spinal Fusion in a Rat Model

Gezici

Ergün

Gürel

et al. 2009

J Korean Neurosurg Soc

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Objective : To evaluate the potential effects of risedronate (RIS) which shows a higher anti-resorptive effect among bisphosphonates, after a posterolateral lumbar intertransverse process spinal fusion using both autograft and allograft in a rat model. Methods : A totoal of 28 Sprague-Dawley rats were randomized into 2 study groups. A posterolateral lumbar intertransverse process spinal fusion was peformed using both autograft and allograft in a rat model. Group I (control) received 0.1 mL of steril saline (placebo) and Group II (treatment) received risedronate, equivalent to human dose (10 µg/kg/week) for 10-weeks period.Results : The fusion rates as determined by manual palpation were 69% in the group I and 46% in the group II (p = 0.251). According to radiographic score, the spinal segment was considered to be fused radiographically in 7 (53%) of the 13 controls and 9 (69%) of the 13 rats treated with RIS (p = 0.851). The mean histological scores were 5.69 ± 0.13 and 3.84 ± 0.43 for the control and treatment groups, respectively. There was a significant difference between the both groups (p = 0.001). The mean bone density of the fusion masses was 86.9 ± 2.34 in the control group and 106.0 ± 3.54 in the RIS treatment group. There was a statistical difference in mean bone densities of the fusion masses comparing the two groups (p = 0.001). Conclusion : In this study, risedronate appears to delay bone fusion in a rat model. This occurs as a result of uncoupling the balanced osteoclastic and osteoblastic activity inherent to bone healing. These findings suggest that a discontinuation of risedronate postoperatively during acute fusion period may be warranted.

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Section: Discussionmentioning

confidence: 99%

The Effect of Risedronate on Posterior Lateral Spinal Fusion in a Rat Model

Gezici

Ergün

Gürel

et al. 2009

J Korean Neurosurg Soc

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“…None of the studies noted whether other analgesics were used by the patients. The total number of patients from the four studies was 187, and all studies concluded that pain was reduced at the local anesthetic site compared to the control site [31][32][33][34].…”

Section: Resultsmentioning

confidence: 99%

Systematic Review of Clinical Evidence for Local Anesthetic Wound Infiltration in Reduction of Post-Surgical Pain

LeBlanc¹,

Sweitzer²

2015

Intern Med

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Local anesthetic infiltration prior to surgical incision closure is a frequently used technique in the operating room. Debate continues, with clinicians, as to the effectiveness of this technique in pain reduction. A literature review using PubMed with the criteria of "local anesthetic infiltration and pain reduction" was conducted for the use of local anesthetic infiltration prior to surgical closure. The search provided 137 results that were then categorized and reviewed, the studies that reviewed the effectiveness (pain reduction) of single dose infiltration of local anesthetics into the surgical wound was small, only numbering 23 studies. The use of local anesthetics before surgical incision or a continuous infusion of the local anesthetics into the surgical wound in the immediate post-operative period is more widely studied, but the effectiveness of this practice varies greatly between studies. The efficacy of using a single pre-closure local anesthetic infiltration ranged from producing a modest reduction in post-surgical pain to no change in post-surgical pain. This systematic review revealed that few studies have examined the effectiveness of local anesthetic infiltration into surgical incisions on post-operative pain outcomes and these results vary greatly as to the effectiveness of this surgical practice.

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“…Hypothesis of infiltrating the wound with bupivacaine in iliac crest harvest lead to significant reduction of pain [2]. Also with ropivacaine and morphine the similar results were observed [3][4][5][6]. To get prolonged pain relief at the incision wound, long acting anesthetic agent should be continuously infiltrated at regular intervals repeatedly depending upon their potency and duration of action.…”

Section: Discussionmentioning

confidence: 96%

Use of a modified epidural catheter for analgesia after iliac crest bone procurement

Degala

Shetty

Sheetal

2009

J. Maxillofac. Oral Surg.

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Background and objectives Autogenous bone grafting is the gold standard procedure for various maxillofacial defects which needs surgical correction and anterior iliac crest is the most common site of harvest. Immediate postoperative pain at the harvested site is a major morbidity associated with it. The aim of the study was to assess the immediate postoperative pain control at the iliac crest graft harvested site by placing an epidural catheter in the incision wound and continuously infiltrating bupivacaine 0.25% at regular intervals. Materials and methods Twenty patients requiring autogenous bone grafting for large maxillofacial defects were chosen for the study. They were divided randomly into two groups of ten each. Group 1 patients were placed with epidural catheter in the incision wound at iliac crest harvested site and group 2 patients did not receive epidural catheter. Continuous infiltration of long acting amide local anesthetic (Bupivacaine) was given to group 1 patients on the postoperative day. Both group 1 & group 2 patients received parenteral analgesic Diclofenac sodium 75mg intramuscularly. Pain at the iliac crest and maxillofacial area was assessed by VAS scale. Also the time of ambulation of the patient was noted. These variables were compared statistically. Results The observed findings were statistically analyzed. Group 1 patients showed significant pain relief at the graft harvested site as compared to group 2 patients. Also the patients in group 1 were ambulated early as compared to group 2 patients. Interpretation and conclusion It was concluded that by placing epidural catheter at the incision wound and continuously infiltrating with bupivacaine 0.25% at iliac crest harvested site at regular intervals effectively controls the immediate acute pain postoperatively and the patient can be ambulated and brought back to normal routine early.

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Reduction in Morbidity After Iliac Crest Bone Harvesting

Cited by 39 publications

References 0 publications

The Effect of Risedronate on Posterior Lateral Spinal Fusion in a Rat Model

The Effect of Risedronate on Posterior Lateral Spinal Fusion in a Rat Model

Systematic Review of Clinical Evidence for Local Anesthetic Wound Infiltration in Reduction of Post-Surgical Pain

Use of a modified epidural catheter for analgesia after iliac crest bone procurement

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