RESUMO
PURPOSE: The aim of this paper is to review the pathophysiology of thermoregulation mechanism, various causes of fever after maxillofacial surgery and the different treatment protocols advised in the literature. DISCUSSION: Fever is one of the most common complaints after major surgery and is also considered to be an important clinical sign which indicates developing pathology that may go unnoticed by the clinician during post operative period. Several factors are responsible for fever after the maxillofacial surgery, inflammation and infection being the commonest. However, other rare causes such as drug allergy, dehydration, malignancy and endocrinological disorders, etc. should be ruled out prior to any definite diagnosis and initiate the treatment. Proper history and clinical examination is an essential tool to predict the causative factors for fever. Common cooling methods like tepid sponging are usually effective alone or in conjunction with analgesics to reduce the temperature. CONCLUSION: Fever is a common postoperative complaint and should not be underestimated as it may indicate a more serious underlying pathology. A specific guideline towards the management of such patients is necessary in every hospital setting to ensure optimal care towards the patients during post operative period.
RESUMO
The aim of this study was to compare the efficacy of femoral nerve block with indwelling catheter-based multiple infiltrations of bupivacaine for postoperative pain management after iliac bone harvesting. Sixty paediatric patients undergoing iliac harvesting were randomized into three groups: group A, preoperative femoral nerve block; group B, multiple bolus infiltration of 0.5% bupivacaine via indwelling catheter at the donor site; group C, controls--single dose of 0.5% bupivacaine infiltration given subcutaneously. The primary outcome measure was postoperative pain intensity at rest and at function. The time to maximum pain score, time to ambulation, duration of analgesia, and length of hospital stay were also assessed. Group B patients had the best pain relief and return to function, however the duration of pain relief was longer in group A. Subjects in group A had concomitant motor blockade causing delayed ambulation. Group C showed the worst outcomes. Indwelling catheter-based infiltration of bupivacaine was the most efficient method for providing enhanced pain relief after iliac bone graft harvesting. There was no increase in operating time or hospital stay. Femoral nerve block provided the next best results, but had the significant disadvantage of motor nerve blockade.