In November 2020, JAMA Surgery published, “Guidelines for Opioid Prescribing in Children and Adolescents After Surgery: An Expert Panel Opinion”. These new guidelines generated important conversation within the pediatric pain medicine community and SPPM. SPPM members Dr. Rita Agarwal, Dr. Vidya Chidambaran and Dr. Stephen Hays submitted a formal response to the study, which was then […]
Question of the Month
You are called to the ED to evaluate a 16-year-old male with a severe headache. The patient has a history of testicular germ cell tumor diagnosed two years ago and is s/p surgical resection and chemotherapy. Today he complains of a 10/10 pulsating pain in the right temporal region. As you enter the patient’s room, you notice that all the lights are off. The patient’s mom quickly greets you at the door, whispering as she introduces herself, she provides you with some further history. You note that the patient is resting in bed with a cold rag over his eyes with a nearby emesis basin filled with vomitus. Mom reports that the patient started experiencing similar headache episodes 6 months ago. He had an ER visit three weeks ago where he was treated with Benadryl, Compazine, and Toradol with limited benefit. He was then admitted for three days for treatment with DHE that was effective, but his headache returned after 48 hours. Mom is asking if something different can be used to help her child.
Based on the current literature, which of the following is true?
A. Propofol has more rebound headaches and a longer length of stay than standard therapy.
B. A RCT in adults concluded that propofol can be used for management of acute migraines with similar rates of recurrence in the propofol group compared to the Sumatriptan group.
C. A case series of 8 patients showed significant reduction in pain scores after receiving propofol in patients who failed a combination of triptans, opioids, NSAIDs, or steroids.
D. Propofol works by blocking the Na+ channels in the CNS and therefore limits the transmission of pain.
