Efficacy of postoperative pain management of the lliac crest bone graft harvesting site in adolescent idiopathic scoliosis patients: a parallel, double-blinded, randomised controlled trial

Abstract

INTRODUCTION: Autogenous iliac crest bone graft (ICBG) harvesting is a common procedure utilised for scoliosis surgery. Postoperative pain at the ICBG donor site is a major concern. This study was a parallel, double-blinded, randomized controlled trial addressing the pain management efficacy of continuous anaesthetic infusion versus saline at the ICBG site in adolescent idiopathic scoliosis (AIS) patients during the immediate postoperative period. METHODS: A level-I trial design of AIS patients (age range, 10-18 years) undergoing posterior instrumentation and fusion at a single institute was performed. Participants were randomised into 2 groups. Group A consisted of control subjects who received 3 mL per hour of saline locally at the ICBG site, whereas Group B consisted of treatment subjects who received constant rate of infusion of 3 mL/hour of 0.25% levobupivacaine. RESULTS: Twelve subjects were recruited (5 in Group A and 7 in Group B). No difference at baseline between groups and parameters was noted. Postoperatively, no difference was found in surgical site pain between groups (p>0.05). However, decreased ICBG and contralateral ICBG pain decreased two-fold in Group B patients in comparison with Group A. Similarly, Group B subjects had notably decreased postoperative overall pain scores. No significant differences were noted for pain scores due to the small sample size. CONCLUSIONS: This pilot study noted a trend that continuous anaesthetic infusion reduced pain at the ICBG site and might further decrease overall physical bodily pain. This study further established a sample size calculation to facilitate largescale studies addressing these parameters.