September 2024
A 9-year-old otherwise healthy male presents with 2-week history of severe post-prandial pain and starvation ketosis from decreased PO intake. He has never had this occur before and has no history of GI problems. Per his parents he is not an anxious child. A CT-angiography of abdomen shows mild narrowing at trunk of celiac artery suggestive of possible median arcuate ligament syndrome (MALS). MALS ultrasound is unequivocal. EGD and biopsies were normal. Remaining work-up has been unrevealing. Surgery is requesting a celiac plexus block for MALS. Which of the following would you likely choose:
- A. Agree to celiac plexus block for diagnostic purposes and/or therapeutic purposes 20.83% (10 votes)
- B. Ask the GI service to place an endoscopic ultrasound guided celiac plexus block 18.75% (9 votes)
- C. I would not recommend celiac plexus block due to lack of high-quality studies to support use of this block for diagnostic or therapeutic purposes for MALS 33.33% (16 votes)
- D. I would request a psychological evaluation of patient prior to deciding 25% (12 votes)
- E. Other: Please specify in text area 2.08% (1 vote)
Other Answer Responses:
- We do not perform these ourselves, so would refer to IR and consult as a team if needed. If IR not in favor, then refer.
- Would also like to assure he has adequate hydration, nutrition first before intervention, as well as good follow up for functional rehabilitation of eating/abd pain (if block is offered it is placed in context of multidisciplinary chronic pain management and close monitoring for refeeding, not assuming a block is going to be a fix by itsself)
Total Answers: 48
Total Votes: 48
July 2024
A 16-year-old female with history of anxiety and urinary tract infection 4 months ago is admitted with continued intermittent severe bladder spasms. Work-up with urology, including cystoscopy, has been reassuring and unrevealing. Urology has patient on oxybutynin XL with little improvement. Pain service is consulted for help with inpatient and outpatient pain management. Which of the following options would you consider for additional treatment?
- A. IV and or PO diazepam while inpatient and discharge with PO diazepam 16.90% (12 votes)
- B. IV and/or PO diazepam while inpatient, but wean off prior to discharge 14.08% (10 votes)
- C. Start tamulosin (Flomax) daily 7.04% (5 votes)
- D. Conservative therapy: pain and anxiety focused psychology, pelvic floor therapy 46.48% (33 votes)
- E. Superior hypogastric block to help with bladder pain/spasms 9.86% (7 votes)
- F. Other muscle relaxant or approach Please specify (free text) 5.63% (4 votes)
Other Answer Responses:
- Would also probably try C (tamsulosin)
Total Answers: 71
Total Votes: 71
May 2024
Please choose the statement(s) below that most closely describes your practice (select all that apply): I typically give intraoperative methadone…
- A. To patients undergoing surgery who will remain inpatient postoperatively 21.34% (35 votes)
- B. To patients undergoing surgery who will be discharged to the outpatient setting (ambulatory/same day surgery) 5.49% (9 votes)
- C. To opioid tolerant patients (i.e. those on chronic opioid therapy) 16.46% (27 votes)
- D. To opioid naïve infants (full term 1 month -1 yr.) 2.44% (4 votes)
- E. To opioid naïve neonates (<1 month, premature infants < 56 weeks PCA/PMA) 0% (0 votes)
- F. To patients who also receive regional anesthesia 5.49% (9 votes)
- G. Along with, other opioids or sedatives 9.76% (16 votes)
- H. When I do administer a single dose methadone I use: 0.1mg/kg 7.32% (12 votes)
- I. When I do administer a single dose methadone I use: 0.15mg/kg 6.10% (10 votes)
- J. When I do administer a single dose methadone I use: 0.2mg/kg 11.59% (19 votes)
- K. When I do administer a single dose methadone I use: 0.25mg/kg 0% (0 votes)
- L. When I do administer a single dose methadone I use: use multiple doses. 2.44% (4 votes)
- M. A dose based on their current opioid therapy. 6.10% (10 votes)
- N. I don’t give methadone intraoperatively. 1.83% (3 votes)
- O. Comments (use text box for comments) 3.66% (6 votes)
Other Answer Responses (Answer O. Comments) –
1. I used methadone for all patients (inpatient or outpatient) with expected multiple days of moderate-severe post-operative pain. I typically dose at least 0.15mg/kg on incision, and give additional doses of 0.05mg/kg towards the last 1/3 of the case, or in the PACU if patient is still haven\’t significant pain. I do not mix with other opioids.
2. IV not available in Canada except by complex special arrangement.
3. We use methadone in single dose mostly for spine fusion and major orthopedics
4. I use methadone fairly routinely in patients who I expect will have moderate to severe pain post op
5. Not ready to use methadone as recommended in some recent studies ( 0.25mg/kg) for outpatients
Total Answers: 164
Total Votes: 46
March 2024
Which of the following postoperative analgesic options do you use in your practice for a child with a tibial long bone fracture at risk for acute compartment syndrome (ACS)?
- A) Perform a single injection popliteal nerve block (+/- adductor canal single injection) 7.69% (4 votes)
- B) Place a popliteal sciatic nerve catheter (+/- adductor canal single injection) 3.85% (2 votes)
- C) Multimodal analgesia with no regional because I am concerned about ACS postoperatively 9.62% (5 votes)
- D) Multimodal analgesia with no regional because our orthopedic surgeons are concerned about ACS 67.31% (35 votes)
- E) Epidural catheter with low concentration LA or opioid only 3.85% (2 votes)
- F) Something else ( please specify-free text) 7.69% (4 votes)
Other Answer Responses –
1. Limit concentration of local anesthetic.
2. Probably no regional because the ‘surgeon’ is concerned about compartment syndrome. There is a case to be made for multimodal with continuous opioid infusion rather than PCA, so that changes in pain level can be identified more quickly against a steady-state opioid background level.
3. Our surgeons no longer want any blocks.
Total Answers: 52
Total Votes: 52
January 2024
An 8kg 5-month-old male infant with history of bladder extrophy presents for primary repair with request for postoperative epidural analgesia. Orthopedics is assisting with pelvic osteotomies with postoperative traction, and the surgical team anticipates at least 10-day hospitalization. Assuming an uneventful epidural catheter placement and no associated complications, how many days would you USUALLY continue the infusion? Pick the answer that best fits your practice, assume untunneled catheter unless answer specifies that it is tunneled.
- A) 5 28.28% (28 votes)
- B) 7 17.17% (17 votes)
- C) 7 only if catheter is tunneled 11.11% (11 votes)
- D) 10 2.02% (2 votes)
- E) 10 only if catheter is tunneled 6.06% (6 votes)
- F) >10 no associated complications and surgical team requests 7.07% (7 votes)
- G) >10 if catheter is tunneled and no associated complications and surgical team requests 18.18% (18 votes)
- H) other – specify in text area 10.10% (10 votes)
Other Answer Responses –
1. If tunneled, longer 7-10 days.
2. 5-10 days, depending on how the patient is doing postoperatively and how the patient is tolerating a oral diet.
3. 4 days.
4. 4.
5. 2 days maximum three if not contaminated by stool.
Total Answers: 99
Total Votes: 99
November 2023
What is your go to pain plan for healthy cooperative adolescents undergoing ACL repair with hamstring autograft? Choose all options that apply.
- A. Femoral or adductor nerve catheter 15% (21 votes)
- B. Adductor or femoral single shot 21.43% (30 votes)
- C. Sciatic/popliteal block 10.71% (15 votes)
- D. iPack 7.86% (11 votes)
- E. Block performed Awake/sedated 9.29% (13 votes)
- F. Block performed under GA before surgical incision 26.43% (37 votes)
- G. Block performed under GA at end of surgery 1.43% (2 votes)
- H. No block 3.57% (5 votes)
- I. Other preferred analgesic techniques: specify in text area 4.29% (6 votes)
Other Answer Responses –
1. Adductor canal, iPACK and genicular blocks performed once under GA.
2. Genicular nerve blocks
3. Multimodal analgesia
Total Answers: 140
Total Votes: 58
September 2023
Are you using buprenorphine in your practice? Check all that apply
- B. Yes, for patients with chronic pain. 16.39% (10 votes)
- C. Yes for all types of pain, including acute, chronic and/or cancer pain. 6.56% (4 votes)
- D. Yes, for opioid use disorder, either alone or with naloxone. 11.48% (7 votes)
- E. No, we currently don’t use it but would be interested in learning more. 49.18% (30 votes)
- F. No and do not have interest. 11.48% (7 votes)
July 2023
An 11-month infant under goes a Left sided thoracotomy for a large benign mass resection. The incision level is at T4 and the child has 2 chest tubes in place at T6 and T7. Hemoglobin, platelets and coagulation factors are normal. Which of the following approaches to postoperative pain management are you most likely to take?
- 1. Place at thoracic epidural at a low to mid thoracic level 45.45% ( 40 votes )
- 2. Thread a catheter to the thoracic level from the caudal space using only US for confirmation 10.23% ( 9 votes )
- 3. Thread a catheter to the thoracic level from the caudal space using fluoroscopy for confirmation ( +/- US) 5.68% ( 5 votes )
- 4. Perform an ESP block ( single shot or catheter) 15.91% ( 14 votes )
- 5. Perform a Paravertebral block ( single shot or catheter) 11.36% (10 votes )
- 6. Multimodal analgesia with no regional 4.55% ( 4 votes )
- 7. Something else 6.82% ( 6 votes )
Other Answer Responses –
1. cryotherapy.
2. Mid thoracic epidural after induction, if need for 1 lung ventilation would do,after epidural placement.
3. Multimodal analgesia Intraoperative Dexmedetomidine infusion and IV Paracetamol 10mg/kg along with Caudal epidural catheter for Regional.
4. Single shot paravertebral at Th4 and Th6.
Total Answers: 88
Total Votes: 88
May 2023
Do you use cannabis or cannabinoid products in your patients with chronic pain?
- A. No, never, not interested. 22.22% (10 votes)
- D. Yes, in select patients (8 votes)
- E. Other 8.89% (4 votes)
Other Answer Responses –
1. I work on the inpatient pain service, not with outpatients with chronic pain. We continue cannabinoids in patients already on them and are always open to adding them if parents ask about it.
2. I monitor for side effects of cannabanioid use in children who\’s parents (or if young adults, themselves) choose to use it. My concerns in outright prescribing are MANY analysis of the current data which have found little efficacy so far from these products, the unregulated and wildly promotional product industry (concerns of purity, dose, contaminants), and evidence we do have of harms to brain development with THC (which many products have in them). However, since I also work with a palliative population and with children with complex chronic disease – I think there needs to be room for us to support informed use for patients with difficult pain who have not found success using evidence based treatments first, and to monitor and evaluate efficacy as well as safety for those patients.
3. End of life care
4. Topical cannabinols preparations
SPPM 12th Annual Meeting