Retrospective Cohort-Based Comparison of Intraoperative Liposomal Bupivacaine Versus Bupivacaine for Donor Site Iliac Crest Analgesia during Alveolar Bone Grafting

Abstract Introduction Bone grafting of alveolar clefts is routinely performed with cancellous bone harvested from the iliac crest. Graft site morbidity is frequently seen, with early post-operative pain being one of the most common complaints. Liposomal bupivacaine has been demonstrated to provide improvement in post-operative pain for patients undergoing bunionectomy or hemorrhoidectomy, which may translate to patients requiring iliac crest bone graft harvest. Methods 38 patients undergoing iliac crest bone harvest were included in the study. 21 patients underwent open iliac crest bone graft harvest with administration of 0.25% bupivacaine at the hip donor site, while 17 patients received local infiltration of 1.3% liposomal bupivacaine. Patient-reported pain scores, total narcotic use, length of stay, and postoperative steps were monitored. Results There were no significant differences in age, weight, distribution of clefts, or choice of donor hip between the two groups. There were no significant differences in length of hospitalization. However, differences were noted in average postoperative pain scores at five of six time points in the first 24 hours, total oral morphine equivalents administered (4.7 ± 5.3 vs. 14.3 ± 12.0), and steps at postoperative day one to three (p Conclusion Reduced pain scores and increased postoperative activity highlights the promise of liposomal bupivacaine to improve postoperative pain management in children undergoing iliac crest bone harvest for alveolar bone grafting.