A Systematic Review of Pain Control Protocols in Alveolar Bone Grafting

Objective To systematically evaluate donor site pain control interventions for iliac crest-based secondary alveolar bone grafting (ABG). Design Systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Setting Original scientific investigations. Patients, Participants Patients undergoing iliac crest-based secondary ABG. Interventions Donor site analgesics and minimally invasive harvest techniques. Main Outcome Measure(s) Pain scores, opioid consumption, length of stay, ambulation variables, complications, and pain assessment scales used. Results 33 studies met the inclusion criteria, encompassing 1925 patients. The most frequently studied methods for donor site pain control were analgesic infusion pumps or catheters (8, 24.2%), local bupivacaine (8, 24.2%), local liposomal bupivacaine (5, 15.2%), transversus abdominis plane blocks (4, 12.1%), and bupivacaine-soaked sponges (4, 12.1%). Most studies evaluated pain scores (21, 63.6%), opioid consumption (17, 51.5%), and length of stay (17, 51.5%). The most used pain assessment scales were generic numeric (1-10) pain rating scales (9, 27.3%), the Visual Analog Scale (9, 27.3%), and the Wong-Baker FACES Scale (3, 9.1%). Use of locally administered liposomal bupivacaine was associated with improved donor site pain scores, reduced opioid consumption, and shorter length of stay. Alternative interventions exhibited variable efficacy. Conclusions Across the available evidence, despite notable variations in bone graft harvest techniques, intraoperative medication dosages, and pain assessment methods, locally administered liposomal bupivacaine was associated with favorable donor site pain control. The significant heterogeneity in the documentation of postoperative pain highlights the need for standardized pain assessment protocols to reliably assess the relative efficacy of donor site pain control strategies for secondary ABG.