The Use of Local Ropivacaine Hydrochloride Infiltration for Analgesia at the Iliac Site in Alveolar Bone Grafting

• Published in: Journal of Japanese Cleft Palate Association Vol. 50; no. 1; pp. 10 - 17
• Main Authors: TAMURA, Tomoko, HICHIJO, Natsuko, NOGUCHI, Tadahide, SUNAGA, Ataru, KONNO, Yu, SUGIURA, Yasushi, OFUSA, Yuri, HAYASHI, Hirosaka, NIHO, Chiaki, MORI, Yoshiyuki
• Format: Journal Article
• Language: Japanese
• Published: Japanese Cleft Palate Association 2025; 一般社団法人 日本口蓋裂学会
• Subjects: alveolar bone grafting; iliac crest harvest; ropivacaine hydrochloride; ロピバカイン塩酸塩; 腸骨採取; 顎裂部骨移植術
• ISSN: 0386-5185; 2186-5701
• DOI: 10.11224/cleftpalate.48-3-4

Alveolar bone grafting is an integral component of surgical interventions for cleft lip and palate. The standard method of bone grafting involves harvesting bone from the ilium, however, postoperative difficulty in walking and delayed ambulation due to sustained pain at the iliac site remain major concerns. Pain control at the harvested site of the iliac is critical for patient satisfaction and improving quality of life post-surgery. We have been using ropivacaine hydrochloride, a long-acting local anesthetic, in the iliac bone grafting area for alveolar bone grafts since 2013, and report its efficacy in the present study. 　Alveolar bone grafting was performed on 101 patients, comprising 60 boys and 41 girls, aged between 7 and 13 years, with 111 alveolar clefts, at the Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical University Hospital between April 2006 and March 2019. Bone graft harvesting was performed on the anterior iliac crest. The 87 patients who received ropivacaine hydrochloride local injection post iliac crest harvesting were designated as the R group, and the remaining 24 patients, who did not receive ropivacaine hydrochloride, were designated as the NR group. Postoperative analgesic use, time to resumption of walking, and postoperative hospital stay were compared between the two groups. 　The mean initial postoperative analgesic administration time was 8.3 hours in the NR group and 8.2 hours in the R group. A total of 70.8 % of patients in the NR group and 56.3 % in the R group needed analgesics before initiation of regular analgesic administration. The mean time to resumption of walking was 42.9 hours in the NR group and 23.5 hours in the R group, with the R group being able to walk significantly earlier. The postoperative hospital stay was 5.5 days in the NR group and 2.9 days in the R group, with the R group having a significantly shorter hospital stay. Multiple regression analysis revealed that the use of ropivacaine hydrochloride significantly influenced postoperative hospital stay. 　Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are routinely used as postoperative analgesics in children. However, the systemic administration of analgesics alone does not provide sufficient pain relief during physical activity, resulting in delayed early ambulation. We report that the use of ropivacaine hydrochloride post iliac crest harvesting results in early postoperative ambulation and shorter hospital stay. Ropivacaine hydrochloride is thus a highly effective pain relief treatment due to its sustained analgesic effects.