To the Editor:—

I was very interested to read the article “Local Administration of Morphine for Analgesia after Iliac Bone Graft Harvest” and would like to commend the authors on a good article. 1I would, however, like to mention two points that may have adversely influenced the resultsof the study discussed.

The patients were scheduled for elective decompressive cervical laminectomy; however, it is not recorded whether these patients were on opioids or nonsteroidal anti-inflammatory drugs (NSAIDs) for preoperative pain management. Chronic persistent cervicogenic pain can be a preoperative presenting complaint and preoperative analgesic usage can influence postoperative analgesic requirements. 2 

The authors also do not adequately describe the method of harvest site injection. Was contact with the donor site bone made or was this merely a local infiltration into the surrounding tissues? In trying to reproduce the local injection technique we were unable to avoid local tissue injection. This unfortunately would result in a third space tissue depot injection of 5 mg of morphine with slower systemic absorption, and hence a more prolonged effect. This morphine effect would be present during the first 24 h of the study period. Unfortunately, the authors did not report pain scores beyond the first 24 h.

References

1.
Reuben SS, Vieira P, Faruqi S, Verghis A, Kilaru PA, Maciolek H: Local administration of morphine for analgesia after iliac bone graft harvest. Anesthesiology 2001; 95: 390–394
2.
Rapp SE, Ready LB, Nessly ML: Acute pain management in patients with prior opioid consumption: A case-controlled retrospective review. Pain 1995; 61: 195–201