Summary of findings 4. Continous donor site local anaesthetic infusion for the prevention of persistent postoperative pain after iliac crest bone graft harvesting.
| Should continuous donor site local anaesthetic infusion or conventional pain control be used for the prevention of persistent postoperative pain after iliac crest bone graft harvesting | ||||||
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Patient or population: people after iliac crest bone graft harvesting
Settings: university hospitals in Europe and North America
Intervention: continuous donor site local anaesthetic infusion Comparison: conventional pain control | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Continous donor site local anaesthetic infusion | |||||
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Persistent pain 3 to 55 months after iliac crest bone graft harvesting (We defined persistent postsurgical pain as new pain that did not exist before the operation, measured using differences in scores based on validated pain scales; patient interview between 3 to 55 months after surgery) |
Low | OR 0.20 (0.04 to 1.09) | 123 (3 studies1) | ⊕⊕⊝⊝ low1 | We accepted study author classification of the presence of persistent postoperative pain. Some assessed only pain vs no pain, others pain and dysaesthesia vs none. Event rates of persistent pain after iliac crest bone graft harvesting were reported between 20% to 40% and was assumed to be around 30%. |
|
| 200 per 1000 | 48 per 1000 (10 to 214) | |||||
| Moderate | ||||||
| 400 per 1000 | 118 per 1000 (26 to 421) | |||||
| High | ||||||
| 600 per 1000 | 231 per 1000 (57 to 620) | |||||
| Adverse effects of continuous local anaesthetic infusion ‐ not reported | See comment | See comment | Not estimable | ‐ | See comment | Adverse effects of regional anaesthesia after iliac crest bone graft harvesting were not systematically reported and due to their low frequency are better investigated in registries. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio | ||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different. Low quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different. Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
1The results are based on only three small studies. Meta‐analysis results based on small numbers tend to overestimate the effects. Including an additional RCT with continuous outcomes in a Bayesian evidence synthesis further strengthens the evidence favouring the intervention (Blumenthal 2005).