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QUESTION OF THE MONTH/VISUAL PEARLS/POLLS OF THE MONTH
MAY 2025 POLL OF THE MONTH
Poll Author: Cheryl J. Hartzell, MD, Cincinnati Children's Hospital Medical Center
MAY 2025 QUESTION OF THE MONTH
Question Authors: Dhiresh Bandaru, Medical Student, University of California and Rita Agarwal, MD, FAAP, Stanford University
A 7-year-old boy (24 kg) undergoes extensive bilateral lower-extremity orthopedic surgery. Epidural catheter placement under general anesthesia proves technically difficult, requiring several needle passes before a catheter is threaded. Twenty-four hours later he develops a bifrontal, throbbing headache with vomiting that is immediately relieved when supine and recurs on sitting or standing. Conservative therapy—including IV fluids, oral caffeine citrate, acetaminophen, ketorolac, and continuation of the local anesthetic infusion through the catheter—fails to provide durable relief. The parents are hesitant about further neuraxial procedures and ask whether any less-invasive options exist before proceeding to an epidural blood patch.
Which of the following interventions has documented success in children for aborting PDPH:
A. Bilateral greater-occipital-nerve blocks with 0.25 % bupivacaine
B. Intravenous cosyntropin (synthetic ACTH) 1 µg kg⁻¹ infused over 5 min
C. Trans-nasal sphenopalatine-ganglion (SPG) block using 4 % lidocaine-soaked applicator
D. Epidural saline bolus via the existing catheter
SPPM 13th Annual Meeting