Society for Pediatric Pain Medicine
Better Care for Children in Pain

A 2.5 month-old, ex- 31 week premature infant is scheduled for an exploratory laparotomy for adhesiolysis and possible small bowel resection. The infant has a history of necrotizing enterocolitis, and underwent a small bowel resection six weeks prior to the operation. Other history includes grade I IVH. The infant was intubated for 3 weeks after birth, and for one week following her initial operation. She required significant amounts of opioid for sedation during mechanical ventilation, and recently finished weaning opioids. The surgeon requests epidural placement to facilitate immediate postoperative extubation and minimize postoperative opioids.
Preoperative lab results include an INR of 1.3 (normalized values 0.8-1.2), PTT of 45.4 (normal 28-37 seconds), fibrinogen 175 mg/dL (normal 200-400), platelets 375 K/uL.

What strategy would you select for postoperative pain management?

A 9 year old female had an epidural placement for postoperative analgesia after osteosarcoma resection and reconstruction of the left leg. The epidural placement required multiple attempts by resident and attending. Patient reported on POD 1 that she is not able to sit up without 8/10 pain described as in the occipital location, dull, and constant. Orthopedic surgery wants to mobilize her early. What are your treatment options?

Spinal anesthesia in infants is a viable anesthesia technique for surgeries such as inguinal hernia. A 2 month-old former 30 week gestation female is scheduled for a unilateral inguinal hernia repair. The resident on the case has a strong desire to perform the spinal. How does practitioner level (Attending/CRNA/Resident) matter in terms of success/failure of placement of an infant spinal?

According to a study by Ivani and colleagues, the optimum concentration of levobupivacaine at 1 ml/kg in a single shot caudal without any additive was 0.2%. What advantage did the 0.2% concentration have over the 0.25% concentration? Was there any impact on analgesia duration?

A 4-year old male with Wilm's tumor is having exploratory laparotomy. He also has a history of severe scoliosis and epidural placement failed. The surgery team requests a "Tap Block". The anesthesia team decides to place a quadratus lumborum block. Which injection site on ultrasound would have a higher chance of paravertebral spread?