Society for Pediatric Pain Medicine
Better Care for Children in Pain

March's question is written by:


Clarice Nguyen, MD
Combined Pediatrics and Anesthesiology Resident
Department of Anesthesiology
Department of Pediatrics
Stanford University

AND


Viviana F. Ruiz, MD
Pediatric Anesthesiology Fellow
Lucile Packard Children's Hospital
Stanford University

An 11-year-old female with a history of precursor B cell acute lymphoblastic leukemia (ALL) is admitted to your pediatric hospital after she was found to have a medullary relapse. The patient has already undergone two rounds of chemotherapy and is now undergoing Chimeric Antigen Receptor (CAR) T-cell therapy.  The patient also has a history of chronic peripheral neuropathy and low back pain and is on scheduled hydromorphone. Four days after starting CAR T-cell therapy the patient develops flu-like symptoms, including fever, headache, and severe muscle and joint pain. Blood cultures have been negative to date. You are consulted to help manage the patient’s acute on chronic pain during CAR T-Cell treatment. Which of the following would BEST address this patient’s current pain symptoms?

January's Question of the Month is written by:    

Elizabeth O'Brien, MD
Pediatric Anesthesiology Fellow
Department of Anesthesiology and Critical Care
Children’s Hospital of Philadelphia


An 8-year-old female with a history of a cleft lip and palate status post staged primary repairs of both defects presents for an alveolar cleft graft. The surgical team intends to use a pyramidal bone block from the anterior iliac crest for the graft site. The patient reports hives with morphine and a history of postoperative nausea/vomiting. As part of an opioid-sparing multimodal analgesic plan, you offer to place a transversalis fascia plane block for post-op pain control. Identify the location for local anesthetic deposition for a successful block:

Figure 1