Analysis of Postoperative Pain at the Anterior Iliac Crest Harvest Site: A Prospective Study of the Intraoperative Local Administration of Ropivacaine

Zenner, Juliane; Hitzl, Wolfgang; Mayer, Michael; Koller, Heiko

Abstract

STUDY DESIGN: This was a prospective randomized comparative study. PURPOSE: The aim of this study was to objectify donor site-related pain following anterior iliac crest graft harvesting, in patients who have undergone multilevel anterior cervical discectomy and fusion with plating (ACDFP); and to assess the effect of an intraoperative local single injection of ropivacaine on postoperative pain. OVERVIEW OF LITERATURE: Multilevel ACDFP can be associated with a high non-union rate. Autogenous iliac bone has been used to increase union rates, although a high incidence of donor site-related pain has been reported.
METHODS
Forty consecutive patients who required 3-level or 4-level ACDFP were prospectively assessed for donor site-related pain. Pain levels were assessed daily for five days postoperative using the visual analog scale (VAS). Patients were randomly assigned to group A or B. In group A patients, 7-10 mL of ropivacaine (0.2%) was injected into the iliac crest after iliac crest graft harvesting. Morphine usage via patient controlled analgesia was calculated. At six months postoperative, patient complaints at the harvest site were documented.
RESULTS
Patients were randomly assigned to group A or B. In group A, ropivacaine was locally administered at the site of the iliac crest graft harvest after fascia closure. In group B, no additional treatments were administered. The average patient age in group A was 56+/-7.6 years, whereas the average age of patients in group B was 52.6+/-10.4 years. Group A had an average of 0.6+/-0.7 previous surgeries per patient, whereas group B had an average of 0.8+/-1.0 previous surgeries per patient. The average number of levels fused in group A was 3.6+/-0.7, whereas the average number of levels fused in group B was 3.7+/-0.9 (all p>0.05). In group A, the mean ropivacaine volume administered was 8.4+/-1.5 mL. No patient complaints regarding chronic pain, were reported six months postoperatively. No complications were encountered from the harvest site, and all patients underwent successful 3-level and 4-level ACDFP. Statistical analysis showed significant differences for VAS on postoperative day 1 (p=0.004) and day 2 (p=0.005).
CONCLUSIONS
VAS assessment showed overall moderate perioperative morbidity in terms of donor site-related pain, which was reduced by administering ropivacaine.