The effect of a single dose of bupivacaine on donor site pain after anterior iliac crest bone harvesting

Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children

“…At almost four years postoperatively, one study with 20 participants (Singh 2007) also found that wound irrigation with local anaesthetic reduced chronic pain after iliac crest bone graft, with an OR 0.03 (95% CI 0.00 to 0.68). However, local infiltration of bupivacaine showed no clear reduction in persistent post-operative pain in another study at 12 months (Barkhuysen 2010). …”

“…We performed the inclusive analysis (Analysis 1.6; Summary of findings 4) to synthesize the effect of local anaesthesia on PPP after iliac crest bone grafting across all available time points, and included three studies with a total of123 participants (Barkhuysen 2010; Gundes 2000; Singh 2007). This analysis could not include Blumenthal 2005, which reported only continuous outcomes.…”

“…No classical (frequentist) analysis was possible for the effects of local anaesthesia on PPP following iliac crest bone graft, as there were only three studies that met our inclusion criteria, one with available data at three months (Gundes 2000), one with data at 12 months (Barkhuysen 2010), and one other study with available data at 55 months postoperatively (Singh 2007). Two additional studies in the iliac crest bone graft surgical subcategory met the inclusion criteria, but reported only continuous pain data (Blumenthal 2005) or nopain outcome (O’Neill 2014).…”

“…Null bias might cause studies to underestimate the benefit of regional anaesthesia for the prevention of persistent pain after surgery, if the regional anaesthesia interventions were not effectively delivered (Higgins 2011a; Woods 1995). Indeed, a number of included studies reported no improved pain control in the immediate postoperative period in the experimental (regional anaesthesia) group, as evidenced by inconsequential differences in pain scores between groups perioperatively, or similar requirements of rescue analgesic medications between groups in the immediate postoperative period (Barkhuysen 2010; Baudry 2008; Bollag 2012; Can 2013; Choi 2016; Fassoulaki 2000; Ibarra 2011; Ju 2008; Karmakar 2014; Katz 1996; Lam 2015; Lee 2013; Liu 2015; Loane 2012; McKeen 2014; Micha 2012; Purwar 2015; Singh 2013; Smaldone 2010; Terkawi 2015b; Vrooman 2015; Xu 2017; Zhou 2016). Two review authors therefore extracted information on null bias for each included study and documented their judgement with supporting evidence (see: Characteristics of included studies).…”

“…No report on the exact number of participants with missing data at 6 or 12 months’ follow-up, only states ”The maximum percentage of missing data for each point (0, 3, 6, and 12 months) in both arms was less than 5% (range: 0%-5%). ITT was performed Selective reporting (reporting bias) Low risk The primary and secondary outcomeslisted in the protocol were all reported Null bias Low risk Quote: “measurement of pain on the VASshowed lower scores at rest and during mobilization in the first 90 min after the end of surgery in the ropivacaine group than in the control group (P < 0.001)... Ropivacaine wound infiltration decreased immediate postoperative pain in the PACU and increased the percentage of pain-free patients (VAS = 0) for the first 48h” Barkhuysen 2010 Methods Double-blinded, clinical RCT Randomization scheme not described Follow-up: 1 year Participants Participants: 200 adults in a hospital setting in Nijmegen, Netherlands Operation: ICBG for cranio-maxillofacial surgery 2 groups, size: 100/100 Age (range): 56 (21–74), 57 (21–80)Men/women: 25/31, 14/28 Interventions Group 1 (bupivacaine) : intraop: after wound closure, participants received a single dose of bupivacaine (10 cc of 2.5 mg/mL bupivacaine with 1:80.000 epinephrine) Group 2 (control) : no intervention given Adjuvants: epinephrineImmediate post-op pain control: no difference between VAS and post-op NSAID use between groups Outcomes Dichotomous: pain/no pain questionnaire at 1 year Continuous: noneOther reported: use of paracetamol (Acetaminophen) and ibuprofen after surgery, duration of surgery, blood loss, and length of incisionAdverse events: perforation of the lateral cortex of the iliac crest, haematoma Notes Financial support statement: “none.”Conflict of interest statement: “none declared” Risk of bias Bias Authors’ judgement Support for judgement Random sequence generation (selection bias) Unclear risk Randomization scheme was not described Allocation concealment (selection bias) Low risk Quote: “for each patient an envelope was drawn” Blinding of participants and personnel (performance bias)...…”