Objective: The purpose of this study was (1) to evaluate the analgesic efficacy of continuous infusion bupivacaine, (2) to evaluate the effects of the site-specific catheter infusion on operating room time, narcotic use, ambulatory status, and length of hospitalization, (3) to monitor for adverse outcomes, and (4) to assess patient/family acceptance. Design: Randomized, double-blinded, and prospective study of bupivacaine versus saline for pain control after anterior iliac crest bone grafting for alveolar cleft repair. Setting: University of Alabama at Birmingham. Patients: A total of 65 pediatric patients with alveolar cleft defects treated between 2006 and 2009. Interventions: Anterior iliac crest bone grafting for alveolar cleft repair with assignment to either a bupivacaine or a saline infusion group. Main Outcome Measures: Physical examination, pain ratings, narcotic use, ambulatory status, operating room time, and length of hospital stay. Results: On the blinded physical exam, 71% in the bupivacaine infusion group and 42% in the saline infusion group were assessed as not experiencing pain at the surgical hip site. The experimental group used less narcotics compared with the control group. No significant differences were noted with operating room time, initial ambulatory status, or length of hospitalization (1.09 versus 1.12 days). Satisfaction and acceptance of the catheter treatment was universal. Conclusions: These results suggest that postoperative infusion of bupivacaine may be efficacious for enhancing pain relief after bone harvest in pediatric patients and may enhance parental perceptions of postoperative care; however, this patient population is difficult to study accurately.