An 18-month-old female presents for right hip open reduction, capsulorrhaphy, adductor tenotomy, iliopsoas lengthening, and pelvic osteotomy +/- femoral osteotomy. As part of the procedure, she will undergo bilateral hip arthrograms. She will have a spica cast applied at the end of the procedure. She has a history of developmental hip dysplasia and recurrent hip dislocations but is otherwise healthy. She has not had anesthesia before.
Suprazygomatic Maxillary Nerve Block in Palatoplasty
Regional anesthesia for children undergoing cleft palate has been increasing in popularity. A new paper retrospectively reviews one center’s outcomes, and found that suprazygomatic maxillary nerve block reduced opioid consumption and length of stay when compared to surgical infiltration.
Read the paper here: https://doi.org/10.1177/10556656241234595
Also, Are you interested in learning about this block? Check out our visual pearl here: https://www.youtube.com/watch?v=UGo993f07t8&t=7s
New Scoping Review on Pediatric Neuropathic Pain and CRPS
Dr. Jennifer Stinson’s team from SickKids, Toronto has published a scoping review on age and sex differences in neuropathic pain and CRPS in the pediatric population. The review found that there is a gap in data for younger children with these conditions as most studies involve adolescents.
Follow the link to read the paper: https://journals.lww.com/clinicalpain/abstract/2024/07000/age_and_sex_differences_in_pediatric_neuropathic.5.aspx
Question of the Month – June 2024
You are consulted for a 1-hr-old 34-week, 2 kg infant who was born to a GIP1 mother with a history of severe OI and chronic pain who has been taking methadone 15mg TID during the pregnancy. Mother is unavailable, but father is at bedside and reports mother has been slowly weaning her dose of methadone from a daily dose of 100 mg a day to limit fetal exposure. She has also received prn hydrocodone/acetaminophen, for a recent fracture and has used 40mg hydrocodone in the last 48 hours. Father reports fetal ultrasounds showing limb length discrepancies and evidence of possible in-utero rib and limb fractures.
No x-rays have been done yet but are planned. Mother is planning to breast feed the infant and to continue taking methadone. The neonatology team is concerned about neonatal opioid withdrawal syndrome (NOWS) as well as pain management for possible fracture pain.
In addition to acetaminophen, documentation of withdrawal and pain scores, which of the following therapeutic approaches is the most appropriate in this patient?
Hypnosis to Avoid Pain from Propofol Injection
Hypnosis is a valuable tool to help ease anxiety and pain. A new study compared addition of lidocaine to propofol with expert hypnosis during IV cannulation and induction with propofol, and found that hypnosis alone, using the “magic glove” technique was effective!
Link to the study: https://onlinelibrary-wiley-com.myaccess.library.utoronto.ca/doi/10.1111/pan.14909
Link to Dr. Leora Kuttner’s magic glove method: https://pediatric-pain.ca/wp-content/uploads/2013/04/The_Magic_Glove12.pdf
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