The Use of Local Ropivacaine Hydrochloride Infiltration for Analgesia at the Iliac Site in Alveolar Bone Grafting

Alveolar bone grafting is an integral component of surgical interventions for cleft lip and palate. The standard method of bone grafting involves harvesting bone from the ilium, however, postoperative difficulty in walking and delayed ambulation due to sustained pain at the iliac site remain major c...

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Published inJournal of Japanese Cleft Palate Association Vol. 50; no. 1; pp. 10 - 17
Main Authors TAMURA, Tomoko, HICHIJO, Natsuko, NOGUCHI, Tadahide, SUNAGA, Ataru, KONNO, Yu, SUGIURA, Yasushi, OFUSA, Yuri, HAYASHI, Hirosaka, NIHO, Chiaki, MORI, Yoshiyuki
Format Journal Article
LanguageJapanese
Published Japanese Cleft Palate Association 2025
一般社団法人 日本口蓋裂学会
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Online AccessGet full text
ISSN0386-5185
2186-5701
DOI10.11224/cleftpalate.48-3-4

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Abstract Alveolar bone grafting is an integral component of surgical interventions for cleft lip and palate. The standard method of bone grafting involves harvesting bone from the ilium, however, postoperative difficulty in walking and delayed ambulation due to sustained pain at the iliac site remain major concerns. Pain control at the harvested site of the iliac is critical for patient satisfaction and improving quality of life post-surgery. We have been using ropivacaine hydrochloride, a long-acting local anesthetic, in the iliac bone grafting area for alveolar bone grafts since 2013, and report its efficacy in the present study.  Alveolar bone grafting was performed on 101 patients, comprising 60 boys and 41 girls, aged between 7 and 13 years, with 111 alveolar clefts, at the Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical University Hospital between April 2006 and March 2019. Bone graft harvesting was performed on the anterior iliac crest. The 87 patients who received ropivacaine hydrochloride local injection post iliac crest harvesting were designated as the R group, and the remaining 24 patients, who did not receive ropivacaine hydrochloride, were designated as the NR group. Postoperative analgesic use, time to resumption of walking, and postoperative hospital stay were compared between the two groups.  The mean initial postoperative analgesic administration time was 8.3 hours in the NR group and 8.2 hours in the R group. A total of 70.8 % of patients in the NR group and 56.3 % in the R group needed analgesics before initiation of regular analgesic administration. The mean time to resumption of walking was 42.9 hours in the NR group and 23.5 hours in the R group, with the R group being able to walk significantly earlier. The postoperative hospital stay was 5.5 days in the NR group and 2.9 days in the R group, with the R group having a significantly shorter hospital stay. Multiple regression analysis revealed that the use of ropivacaine hydrochloride significantly influenced postoperative hospital stay.  Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are routinely used as postoperative analgesics in children. However, the systemic administration of analgesics alone does not provide sufficient pain relief during physical activity, resulting in delayed early ambulation. We report that the use of ropivacaine hydrochloride post iliac crest harvesting results in early postoperative ambulation and shorter hospital stay. Ropivacaine hydrochloride is thus a highly effective pain relief treatment due to its sustained analgesic effects.
AbstractList Alveolar bone grafting is an integral component of surgical interventions for cleft lip and palate. The standard method of bone grafting involves harvesting bone from the ilium, however, postoperative difficulty in walking and delayed ambulation due to sustained pain at the iliac site remain major concerns. Pain control at the harvested site of the iliac is critical for patient satisfaction and improving quality of life post-surgery. We have been using ropivacaine hydrochloride, a long-acting local anesthetic, in the iliac bone grafting area for alveolar bone grafts since 2013, and report its efficacy in the present study.  Alveolar bone grafting was performed on 101 patients, comprising 60 boys and 41 girls, aged between 7 and 13 years, with 111 alveolar clefts, at the Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical University Hospital between April 2006 and March 2019. Bone graft harvesting was performed on the anterior iliac crest. The 87 patients who received ropivacaine hydrochloride local injection post iliac crest harvesting were designated as the R group, and the remaining 24 patients, who did not receive ropivacaine hydrochloride, were designated as the NR group. Postoperative analgesic use, time to resumption of walking, and postoperative hospital stay were compared between the two groups.  The mean initial postoperative analgesic administration time was 8.3 hours in the NR group and 8.2 hours in the R group. A total of 70.8 % of patients in the NR group and 56.3 % in the R group needed analgesics before initiation of regular analgesic administration. The mean time to resumption of walking was 42.9 hours in the NR group and 23.5 hours in the R group, with the R group being able to walk significantly earlier. The postoperative hospital stay was 5.5 days in the NR group and 2.9 days in the R group, with the R group having a significantly shorter hospital stay. Multiple regression analysis revealed that the use of ropivacaine hydrochloride significantly influenced postoperative hospital stay.  Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are routinely used as postoperative analgesics in children. However, the systemic administration of analgesics alone does not provide sufficient pain relief during physical activity, resulting in delayed early ambulation. We report that the use of ropivacaine hydrochloride post iliac crest harvesting results in early postoperative ambulation and shorter hospital stay. Ropivacaine hydrochloride is thus a highly effective pain relief treatment due to its sustained analgesic effects.
Alveolar bone grafting is an integral component of surgical interventions for cleft lip and palate. The standard method of bone grafting involves harvesting bone from the ilium, however, postoperative difficulty in walking and delayed ambulation due to sustained pain at the iliac site remain major concerns. Pain control at the harvested site of the iliac is critical for patient satisfaction and improving quality of life post-surgery. We have been using ropivacaine hydrochloride, a long-acting local anesthetic, in the iliac bone grafting area for alveolar bone grafts since 2013, and report its efficacy in the present study. Alveolar bone grafting was performed on 101 patients, comprising 60 boys and 41 girls, aged between 7 and 13 years, with 111 alveolar clefts, at the Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical University Hospital between April 2006 and March 2019. Bone graft harvesting was performed on the anterior iliac crest. The 87 patients who received ropivacaine hydrochloride local injection post iliac crest harvesting were designated as the R group, and the remaining 24 patients, who did not receive ropivacaine hydrochloride, were designated as the NR group. Postoperative analgesic use, time to resumption of walking, and postoperative hospital stay were compared between the two groups. The mean initial postoperative analgesic administration time was 8.3 hours in the NR group and 8.2 hours in the R group. A total of 70.8 % of patients in the NR group and 56.3 % in the R group needed analgesics before initiation of regular analgesic administration. The mean time to resumption of walking was 42.9 hours in the NR group and 23.5 hours in the R group, with the R group being able to walk significantly earlier. The postoperative hospital stay was 5.5 days in the NR group and 2.9 days in the R group, with the R group having a significantly shorter hospital stay. Multiple regression analysis revealed that the use of ropivacaine hydrochloride significantly influenced postoperative hospital stay. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are routinely used as postoperative analgesics in children. However, the systemic administration of analgesics alone does not provide sufficient pain relief during physical activity, resulting in delayed early ambulation. We report that the use of ropivacaine hydrochloride post iliac crest harvesting results in early postoperative ambulation and shorter hospital stay. Ropivacaine hydrochloride is thus a highly effective pain relief treatment due to its sustained analgesic effects. 【緒言】顎裂部骨移植術は,唇顎口蓋裂の一連の治療において欠かすことのできない重要な手術である。移植骨は腸骨より採取する方法が標準的であるが,術後は腸骨採取部の疼痛による歩行困難や離床の遅れがしばしば問題となる。腸骨採取部の疼痛コントロールは患者のQOL 向上や患者満足度の観点からも重要である。当科では2013 年より顎裂部骨移植術の腸骨採取部に長時間作用型局所麻酔薬であるロピバカイン塩酸塩を使用しており,今回,われわれはその有効性について検討した。【方法】2006 年4 月から2019 年3 月までに自治医科大学附属病院歯科口腔外科・矯正歯科で顎裂部骨移植術を施行した患者101 名(男性60 名,女性41 名),111 顎裂を対象とした。腸骨採取は前腸骨より行い,採取後にロピバカイン塩酸塩を使用しなかった群をNR 群(24 例),ロピバカイン塩酸塩を使用した群をR 群(87 例)として,術後の初回鎮痛薬使用開始時間,歩行開始時期,術後在院日数について検討した。【結果】鎮痛薬の初回平均投与時間はNR 群8.3 時間,R 群8.2 時間であった。また,全体のうち鎮痛薬の内服を必要とした患者割合はNR 群70.8 %,R 群56.3 % であった。平均歩行開始時期はNR 群42.9 時間,R 群23.5時間で,R 群で有意に術後早期の歩行が可能であった。術後在院日数はNR 群5.5 日,R 群2.9 日で,R 群で有意に在院日数が短く,重回帰分析においてもロピバカイン塩酸塩の使用の有無が術後在院日数に有意に影響する結果となった。【考察】アセトアミノフェンやNSAIDs(非ステロイド性抗炎症薬)などの全身的な鎮痛薬投与のみでは体動時の十分な鎮痛が得られず,離床の遅れにつながることがある。今回,腸骨採取後にロピバカイン塩酸塩を使用することで,術後早期の離床と在院日数の短縮が可能であることが示された。ロピバカイン塩酸塩は,持続性のある鎮痛効果が期待でき,腸骨採取部の疼痛コントロールに有効 であるといえた。
Author NOGUCHI, Tadahide
HAYASHI, Hirosaka
HICHIJO, Natsuko
MORI, Yoshiyuki
NIHO, Chiaki
SUNAGA, Ataru
TAMURA, Tomoko
OFUSA, Yuri
SUGIURA, Yasushi
KONNO, Yu
Author_FL 今野 悠
TAMURA Tomoko
OFUSA Yuri
七條 なつ子
NIHO Chiaki
HAYASHI Hirosaka
森 良之
杉浦 康史
野口 忠秀
須永 中
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Snippet Alveolar bone grafting is an integral component of surgical interventions for cleft lip and palate. The standard method of bone grafting involves harvesting...
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SubjectTerms alveolar bone grafting
iliac crest harvest
ropivacaine hydrochloride
ロピバカイン塩酸塩
腸骨採取
顎裂部骨移植術
Title The Use of Local Ropivacaine Hydrochloride Infiltration for Analgesia at the Iliac Site in Alveolar Bone Grafting
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