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Abstract: Donor Site Analgesia In Cleft Alveolar Reconstruction: Examining The Effects Of Minimal Access Surgical Techniques Compared To Regional Anesthesia Techniques
Authors: Christine Fisher, MD1
Zoe MacIsaac, BA1
Katherine Boretsky BS2
Lorelai Grunwaldt, MD1
Karen Boretsky MD2
Joseph Losee, MD1
Anand Kumar, MD1
Institutions: 1. Division of Pediatri
Univeristy of Pittsburgh
2012-02-16
Presenter: Christine Fisher MD
Affidavit:
The resident did more than 50% of the work in this research project
Director Name: Joseph Losee MD
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
The study goal is to improve patient care by minimizing postoperative patient morbidity.
How will your presentation be used by practicing physicians in the audience?
This study will be used by conference attendees to improve clinical practice and reduce length of stay and cost of care.
Background:
The optimal prevention and treatment of pain associated of iliac crest bone graft donor sites for the treatment of cleft alveolus defects has not been well characterized. The aim of this study is to assess the efficacy of regional anesthesia in iliac crest bone harvest.
Methods:
A retrospective review of 46 patients undergoing iliac crest bone graft (ICBG) harvest using traditional open ICBG alone (Group 1, n=21), minimal access ICBG (Group 2, n=20), or minimal access ICBG with paravertebral anesthetic block (Group 3, n=5) was performed. Post operative pain scores, narcotic consumption, and hospital stay were analyzed.
Results:
The average time to first narcotic was 258min in Group 1, 202.7min in Group 2, and 574.6min in Group 3. Total narcotic use was 0.117mg/kg in Group 1, 0.125mg/kg in Group 2, and 0.065mg/kg in Group 3. The average pain score (VAS) was 2.96, 1.83, and 1.08 respectively. The average length of stay was 1.45 for Group 1, 1.36 for Group 2, and 1.0 for Group 3. There were no wound infections, bleeding requiring reoperation, or mortalities.
Conclusions:
The addition of regional anesthesia to minimal access ICBG harvest significantly reduces time to first narcotic use. Regional anesthesia showed a trend toward lower pain score (VAS) and total narcotic use, but did not significantly reduce the length of hospital stay compared to either group. Minimal access techniques significantly lowered the pain score but not the length of stay, time to first narcotic, or total narcotic use compared to traditional open techniques.
