Use of the On-Q Pain Pump in Alveolar Bone Grafting: Effect on Hospit Length of Stay

Abstract

Although there is a trend toward a shorter length of stay in our patients who received the On-Q pump, this finding was not statistically significant. Given the expense and additional burden of care associated with the device, we have become more selective in its utilization.

A Multimodal Preemptive Analgesic Protocol for Alveolar Bone Graft Surgery: Decreased Pain, Hospital Stay, and Health Care Costs

“…Sbitany et al (2010) observed a significant decrease from 2.9 days to 1.4 days in the hospital with the use of a pain pump. However, the 2 other studies did not demonstrate a significant decrease with or without the use of the On-Q pain pump with durations of 0.52 and 0.37 days for 1 study and 1.09 and 1.12 days for the other (Meara et al, 2011; Muzaffar et al, 2016). Although the contributing factors are unclear, both of these reports had short hospitalizations associated without the use of a pain pump, which does not allow a significant decrease to be observed.…”

“…Secondary ABG with iliac crest bone is standard in many comprehensive cleft care protocols (Paterson et al, 2016), despite the fact that donor site pain remains a significant limitation (Rawashdeh, 2008; Meara et al, 2011; Myeroff and Archdeacon, 2011). Attempts to more effectively manage donor site pain have often been met with disappointing results (Wilkes and Thomas, 1994; Hahn et al, 1996; Morrison and Jacobs, 2003; Blumenthal et al, 2005; Singh et al, 2005; Morgan et al, 2006; Baig et al, 2006; Singh et al, 2007; Charous, 2008; Coulthard et al, 2008; Elder et al, 2008; Ouaki et al, 2009; Yoost et al, 2009; Sbitany et al, 2010; Sbitany et al, 2010; Meara et al, 2011; Visoiu, 2014; Muzaffar et al, 2016). Furthermore, alternatives to autologous bone have been explored to alleviate donor site morbidity, such as allograft and Bone Morphogentic Protein-2 (BMP-2) (Francis et al, 2013; Sivak et al, 2014).…”

“…Because opiate administration and pain scores can vary widely depending on nursing care, we selected hospital LOS as our primary outcome. Few studies have used LOS as the primary outcome when evaluating the efficacy of a pain pump in children who undergo ICBG (Sbitany et al, 2010; Meara et al, 2011; Muzaffar et al, 2016). These 3 studies, however, demonstrate conflicting findings.…”

“…To minimize postoperative donor site pain, preemptive analgesia strategies have been employed including intravenous analgesics, intraoperative local anesthetic sponges, nerve blocks, and local anesthetic infusion pumps (Wilkes and Thomas, 1994; Hahn et al, 1996; Hoard et al, 1998; Blumenthal et al, 2005; Singh et al, 2005; Singh et al, 2007; Coulthard et al, 2008; Dashow et al, 2009; Ouaki et al, 2009; Isyanov and Suresh, 2009; Sbitany et al, 2010; Meara et al, 2011; Gamli et al, 2012; Visoiu, 2014; Muzaffar et al, 2016). Intraoperative use of bupivacaine at the iliac crest donor site has been shown to delay the onset of pain, decrease postoperative opioid use, and lead to earlier ambulation (Hoard et al, 1998; Dashow et al, 2009; Gamli et al, 2012).…”

“…Intraoperative use of bupivacaine at the iliac crest donor site has been shown to delay the onset of pain, decrease postoperative opioid use, and lead to earlier ambulation (Hoard et al, 1998; Dashow et al, 2009; Gamli et al, 2012). Recent studies of indwelling pain catheters have reported conflicting findings regarding length of hospitalization after iliac crest bone graft (ICBG) for secondary alveolar reconstruction (Sbitany et al, 2010; Meara et al, 2011; Muzaffar et al, 2016).…”