This is a prospective study of postoperative pain at iliac graft donor site in 40 selected cases undergoing bone graft procedures from the iliac bone. Comparison was made between 3 different surgical approaches (superior, medial and superior-lateral). Severity of pain after operation was assessed using 10cm. visual analogue scale (VAS). All patients were followed up as outpatient visits every 2 weeks for period of 3 months. All patients had significant donor site pain postoperatively; moreover, in 83.3% of patients the pain was more severe at donor site than the recipient site. The precise cause of donor site pain remained obscure. However, in 87.5% of cases pain which, was closely related to position as typically aggravated by walking could indicate a local muscular or periosteal origin. The superior-lateral approach was associated with the lowest level of measured pain at donor site which, was mostly due to minimal muscles stripping and also the use of outer table. The highest level of pain was associated with the use of the superior approach, which was probably due to excessive muscle stripping and reflection of both gluteal and abdominal muscles. Donor site pain was substantially higher in patients where both tables of ilium were involved. In 10 patients (superior-lateral approach), bupivacaine hydrochloride 0.5% (Marcaine) had been used to infiltrate their donor wound during operation and comparison was made with another 10 patients as control. Local infiltration with pubivacaine produced a significant reduction in postoperative donor site pain.