Bupivacaine infusion for iliac crest donor sites.

Pain is common after a bone graft has been taken from the iliac crest (Kurz, Garfin and Booth 1989). Local wound infiltration with bupivacaine at closure is effective, but relief lasts for only four hours (Todd and Reed 1991). We report a method of infusing bupivacaine which gives effective and lasting analgesia. Patients and methods. Patients requiring iliac crest grafts were randomly selected to receive either bupivacaine infiltration at wound closure or bupivacaine infusion postoperatively. For the infusion group, a fine-bore catheter was tunnelled into the wound between muscle and fat and used to infiltrate 0.5% bupivacaine solution at a rate of 5 ml/hour for 48 hours by a syringe driver. A drain was also used; drain and catheter were removed after two days. For the infiltration group 10 ml of 0.5% bupivacaine solution was injected into the soft tissues by needle and syringe immediately before skin closure. A drain was used. At 24 hours postoperatively, patients graded their