How Much Pain Medication Do Patients Require After Posterior Iliac Crest Bone Graft to the Alveolar Cleft?

Objective: The purpose of this study was to quantify analgesic use following alveolar cleft bone grafting (ABG) utilizing a posterior iliac crest (PIC) donor site. Design: This is a prospective cohort study of consecutive patients that underwent ABG with PIC in a 10 month period from November 2022 to September 2023. Setting: Tertiary care free-standing pediatric hospital. Participants: Patients with cleft lip and alveolus with or without cleft of the secondary palate undergoing alveolar bone graft with cancellous marrow from the PIC. Interventions: All patients underwent ABG and recorded analgesic use afterwards. Main Outcome Measure: The main outcome variable was total pain medication utilization during the first 10 postoperative days (PODs). Results: 22 subjects (72.7% male, 54.5% Caucasian 72.7% unilateral and 27.3% bilateral clefts) recorded pain medication use. Total duration of analgesic use (any type) was 3.86 +/- 1.7 postoperative days. 10 subjects (45.5%) did not use opioid medication postoperatively. The remaining 12 subjects (54.5%) used a median of 12 (0, 19) morphine milli-equivalents (MME), equal to 1.6 (0, 2.53) doses of 5 mg oxycodone. An average of 9.9 +/- 5.6 doses of acetaminophen and 9.1 +/- 4.7 doses of a non-steroidal anti-inflammatory drug (NSAID) were administered. No subject used opioids after POD3. Patients with unilateral clefts used more acetaminophen (p = 0.02); otherwise, there were no significant differences in outcomes based on any predictor variable (p > 0.05). Conclusions: Analgesic requirements after ABG with PIC were minimal, with nearly half of patients taking no postoperative opioids. As such, judicious opioid prescribing is prudent.