Virnik A S, Gaggl A, Likar R, Stettner H, Chiari F M
Abteilung für Mund-, Kiefer- und Gesichtschirurgie, Landeskrankenhaus Klagenfurt, Klagenfurt, Osterreich.
Schmerz. 2009 Jun;23(3):259-62, 264-6. doi: 10.1007/s00482-009-0784-7.
Severe pain is one of the main problems after harvesting iliac crest transplants. In this randomized double-blind study differences in the peripheral and central effects of opiates for pain treatment in the iliac crest region after augmentation of the severely resorbed maxilla were examined.
In 20 consecutive patients with severe atrophy of the edentulous maxilla, augmentation was performed with the use of iliac crest transplants. In 10 patients a gelatine sponge soaked with a 10 mg morphine hydrochloride solution was placed in the iliac region after harvesting the transplant ipsilaterally for local opiate therapy. In the control group the same opiate was injected into the contralateral glutaeus maximus muscle for systemic therapy. Both groups were followed up for pain intensity every 2 h during the first 48 h and 3 times a day from postoperative days 3-10. Thereafter the patients were followed up 1, 3, 6 and 12 months postoperatively. At each time of control the VAS score, as well as the quality of pain with and without movement and the consumption of NSAIDs were registered.
Lower pain values were registered in the control group within the early postoperative period, whereas the mean VAS score was less from postoperative days 3-10 in the study group (2.3 compared to 1.3 VAS). The consumption of NSAIDs corresponded to the pain scores in both groups during the control periods. There were no statistically significant differences for long term results at 1, 3, 6 and 12 months postoperatively.
The effect of centrally given opiates is more effective in the early postoperative period. In the early rehabilitation period the effect of intraoperatively local peripherally placed opiates is superior to intraoperatively centrally administered opiates.
