Liposomal Bupivacaine for Additional Analgesia at Iliac Crest Donor Site in Alveolar Bone Graft Surgery: A Retrospective Pilot Study

To study postoperative pain control differences between liposomal bupivacaine (LB) and immediate-release bupivacaine (IRB) as measured by the use of narcotics after iliac crest graft harvesting for alveolar bone grafting (ABG). A retrospective review was completed at a single-site pediatric stand-alone hospital of patients undergoing ABG with iliac crest bone grafting (ICBG) between May 1, 2020, through May 31, 2023. Patients, Participants Patients who underwent ABG with ICBG were split into three cohorts: LB monotherapy, IRB monotherapy, or LB with IRB. Interventions All ABG and ICBG procedures were completed by a single surgeon who is a member of our dedicated cleft lip and palate team. Main Outcome Measures The primary outcome was the difference in oral morphine equivalent (OME) requirements from the immediate postoperative time period to the time of discharge. Patients treated with LB monotherapy required significantly less OME during their inpatient stay, with an average of 0.21 mg/kg ± 0.15 mg/kg in the LB group, 0.67 mg/kg ± 0.37 mg/kg in the IRB group, and 0.28 mg/kg ± 0.07 mg/kg in the LB with IRB group ( P = .001). There was no significant difference in the total number of analgesic medication doses administered throughout the hospitalization among the three groups. Utilization of LB intraoperatively may decrease the need for postoperative opioid treatment for postoperative pain control when harvesting ICB for ABG in the cleft lip and palate population compared to alternative local anesthetics.