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

Abstract

Rationale: Autogenous iliac crest bone graft (ICBG) harvesting is a common procedure utilized for scoliosis surgery. Postoperative pain at the ICBG donor-site is a major concern. The following is a parallel, double-blinded, randomized controlled trial addressing the pain management efficacy of continuous anesthetic infusion versus saline at the ICBG site in AIS patients during the immediate postoperative period was addressed. Methods: A Level I trial design of AIS patients (age range: 10 to 18 years of age) undergoing posterior instrumentation and fusion at a single institute was performed. Participants were randomized into two groups. Group A consisted of control subjects who received 3ml per hour of saline locally at the ICBG site and Group B consisted of treatment subjects who received a constant rate of infusion of 3ml/hour of 0.25% levobupivacaine. Results: Twelve subjects were recruited (n=5 Group A; 7 Group B). No difference was noted at baseline between groups and parameters. Postoperatively, no difference was noted 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 to Group A. Similarly Group B subjects had notably decreased postoperative overall pain scores. No significant differences were noted for the pain scores due to the small sample size. Conclusions: This pilot study noted a trend that continuous anesthetic infusion reduces pain at the ICBG site and may further decrease overall physical bodily pain. This study further established a sample size calculation to facilitate large-scale studies addressing these parameters.