title: Catheter-based donor site analgesia after rib grafting: a prospective, randomized, double-blinded clinical trial comparing ropivacaine and bupivacaine.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Meenakshiammal Dental College and Hospital, Maduravoyal, Chennai, India. anantparameswaran@yahoo.com
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Anantanarayanan
authors.forename: Dharmesh Kumar
authors.initials: DK
authors.lastname: Raja
authors.forename: J Naveen
authors.initials: JN
authors.lastname: Kumar
authors.forename: P
authors.initials: P
authors.lastname: Sneha
authors.forename: Amelia
authors.initials: A
authors.lastname: Christabel
authors.forename: Ramanathan
authors.initials: R
authors.lastname: Manikandhan
authors.forename: Namasivayam
authors.initials: N
authors.lastname: Elavazhagan
mesh_terms: D000293:Adolescent; D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D002404:Catheterization / Q000379:methods; D004311:Double-Blind Method; D004431:Ear, External / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D012225:Rhinoplasty; D012272:Ribs / Q000637:transplantation*; D000077212:Ropivacaine; D020858:Tissue and Organ Harvesting / Q000009:adverse effects; D060053:Transplant Donor Site; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine