Does Ultrasound-Guided Transversus Abdominis Plane Block Reduce Donor Site Pain After Harvesting Anterior Iliac Crest Bone Grafts

Abstract

The most common side-effect of anterior iliac crest (AIC) bone grafting is postoperative pain. The purpose of this study was to investigate the effectiveness of ultrasound-guided transversus abdominis plane (TAP) block for reducing donor site pain after harvesting AIC bone graft. Patients scheduled for unilateral alveolar cleft repair with AIC bone grafting, regardless of age, were enrolled in this prospective, randomized controlled trial study, divided into 2 groups: group T (performing TAP block) and group C (without TAP block). Postoperative pain at the alveolar cleft and AIC site were assessed using a visual analog scale (VAS) at the immediate postoperative time, 6, 12, and 24 hours after surgery. Morphine consumption during operation, postoperatively in the first 24 hours and total dosage until discharge and its side effects were also observed. Patients' satisfaction was accessed. MANOVA was used to evaluate the effects of treatment on those outcome variables. The P value <.05 was considered statistically significant. Eighteen patients, with a mean age of 14.39±3.70 years, were enrolled in this study. Pain scores at the AIC site in group T were statistically less significant than in group C for all times with P value <.001, <0.001, 0.002, and 0.004 consequently. Pain scores at the AIC site at 24 hours had no statistically significant difference after Bonferroni correction. There was statistically significant greater patients' satisfaction in pain control at the AIC site in group T than in group C with P value <.001. Group T revealed, statistically significant, less morphine consumption than group C at both the first 24 hours and postoperatively, totally until discharge with P value <.001. No complications of TAP block were reported in this study. There was a statistically significant lower incidence of nausea in group T than in group C with Pvalue 0.029. The ultrasound-guided TAP block is an effective postoperative pain controller and can decrease postoperative morphine consumption at AIC bone harvesting.