Catheter-based donor site analgesia after rib grafting: a prospective,
randomized, double-blinded clinical trial comparing ropivacaine and bupivacaine.
Author(s): Anantanarayanan P(1), Raja DK, Kumar JN, Sneha P, Christabel A, Manikandhan R,
Elavazhagan N.
Affiliation(s): Author information:
(1)Department of Oral and Maxillofacial Surgery, Meenakshiammal Dental College and
Hospital, Maduravoyal, Chennai, India. anantparameswaran@yahoo.com
Publication date & source: 2013, J Oral Maxillofac Surg. , 71(1):29-34
PURPOSE: Although ribs provide the best source of cartilage for reconstruction,
its harvesting is associated with significant postoperative pain and sometimes
incapacitating functional deficit. The lack of studies in the maxillofacial
literature on regional analgesia for rib harvests stimulated this study design.
This study compared ropivacaine with bupivacaine in providing postoperative
analgesia after rib harvest.
PATIENTS AND METHODS: Patients who needed rib grafting for maxillofacial
reconstructive procedures were enrolled in this prospective, randomized,
double-blinded clinical trial. Patients were randomly allocated to 1 of 2 groups
with different modalities of anesthesia against a control group. A catheter was
embedded in the rib donor site in all patients. Patients in group A received
0.75% ropivacaine, those in group B received 0.5% bupivacaine, and those in croup
C patients received normal saline and served as the controls. The outcome
variables were the subjective and objective pain scores, the duration of action,
and the efficacy of the drugs after rib harvest. Dependent variables were the
need for a rescue analgesic by the patient and the duration of hospital stay. The
subjective intensity of pain at rest was calculated using the visual analog
scale. The objective pain scores at function were evaluated by comparing
preoperative with postoperative values of incentive spirometry, breath-holding
test, maximal chest expansion, and match-blowing test. The t test and paired
samples test were used to the analyze data, and a P value less than .05 was
considered significant.
RESULTS: Forty-two patients were enrolled in this study. Patients in groups A and
B showed significant pain relief compared with group C. Patients in group A
showed significantly less pain at rest (2.8±0.894) compared with those in group B
(3.7±0.875; P<.05). Patients in group A also showed significantly less in pain at
function (3.8±0.894) compared with those in group B (4.7±0.923; P<.05). Patients
in group A showed a minimal need for a rescue bolus compared with those in group
B. The duration of action for ropivacaine was longer by a mean difference of 11
hours. No noteworthy difference was seen for the duration of stay in the
hospital.
CONCLUSIONS: The use of catheter-based analgesia after rib harvesting provides
excellent postoperative comfort, with ropivacaine providing an earlier return to
normal function compared with bupivacaine. The duration of action of ropivacaine
was significantly longer and, hence, decreased the need for rescue analgesics.
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