Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Int J Oral Maxillofac Surg. 2010 Mar;39(3):260-5. doi: 10.1016/j.ijom.2009.10.015. Epub 2009 Dec 2.
Transplants from the anterior iliac crest are used for most reconstructive procedures in cranio-maxillofacial surgery. The advantages are easy accessibility, the ability to work in two teams and the amount of corticocancellous bone available; disadvantages are postoperative pain and gait disturbances. To reduce donor-site pain, the effect of a single dose of bupivacaine (10 cc of 2.5mg/cc with 1:80.000 epinephrine) was studied. 200 consecutive patients, who underwent anterior iliac crest bone harvesting for reconstructive procedures, were randomly divided into those receiving bupivacaine and those not. They completed a standardized questionnaire. Patients scored the intensity of the pain and difficulties walking at different times with a visual analogue scale. They recorded analgesics used. 98 questionnaires were eligible for analysis. No differences between the bupivacaine and the control group were detected for postoperative pain and gait disturbance. There is no support for administration of a single dose of bupivacaine to reduce pain in the first postoperative days. The surface area of the removed bone had a significant influence on pain and walking; pain is related to the local osseous damage or periosteal stripping rather than to the length of incision or the operation time.
髂前嵴移植被广泛应用于颅颌面外科的大多数重建手术。其优点是易于获取、能够进行双团队操作以及有足够的皮质松质骨可用；缺点是术后疼痛和步态障碍。为了减轻供区疼痛，研究了单次布比卡因（2.5mg/cc 的 10cc 加 1:80,000 肾上腺素）的效果。200 例连续接受髂前嵴骨移植以进行重建手术的患者被随机分为接受布比卡因和不接受布比卡因的两组。他们完成了一份标准化问卷。患者使用视觉模拟量表在不同时间对疼痛强度和行走困难进行评分，并记录使用的镇痛药。98 份问卷符合分析要求。在术后疼痛和步态障碍方面，布比卡因组与对照组之间没有差异。单次给予布比卡因不能减轻术后最初几天的疼痛。所切除骨的表面积对疼痛和行走有显著影响；疼痛与局部骨损伤或骨膜剥离有关，而与切口长度或手术时间无关。
