Question of the Month Archives - Society for Pediatric Pain Medicine

Question of the Month – December 2025

A 10-year-old female, weighing 35 kg and six months post–liver transplantation, is referred to the pain clinic for evaluation of abdominal wall pain accompanied by bilateral leg pain following a complicated postoperative course. She is receiving tacrolimus and reports burning and deep aching pain that worsens with activity. Her average pain score is 6–7/10, sleep is disrupted, and she uses intermittent oxycodone at home with partial relief. Physical examination revealed focal tenderness near the transplant incision, with no redness, swelling, or other physical abnormalities. The patient also reported poor sleep quality, while laboratory tests showed normal allograft function.

A. Increase the dose of oxycodone and arrange for a short opioid taper after pain control is achieved.

B. Evaluate for tacrolimus-associated pain syndrome (CIPS) and discuss immunosuppressant adjustment with the transplant team.

C. Start gabapentin and schedule a diagnostic nerve block of the abdominal wall.

D. Recommend immediate revision surgery to explore potential surgical complications.

Correct! Wrong!

Question of the Month - December 2025

Question of the Month – November 2025

A 15-year-old, 50 kg female with a right upper lobe mass presents for lobectomy via open thoracotomy. She has a history of anxiety and depression. As part of a multimodal analgesic regimen, her anesthesiologist plans to perform an ultrasound guided erector spinae plane block. Which of the following complications is most likely?

A. Epidural hematoma

B. Intravascular injection of local anesthetic

C. Failed block

Correct! Wrong!

Question of the Month - November 2025

Question of the Month – October 2025

A 10-year-old girl (33 kg) undergoes left upper-arm fracture fixation under general endotracheal anesthesia. Sixty minutes after placement of a supraclavicular block, she develops acute hypotension (BP 65/40 mm Hg), tachycardia (HR 145 bpm), frequent Premature ventricular contractions (PVCs), and desaturation (SpO₂ 82%). At this time, reduced movement of the left hemithorax is visible. What is the most critical immediate next step?

A. Auscultate bilateral lung fields

B. Administer 20% intralipid IV bolus (1.5 mL/kg)

C. Start IV epinephrine (1 μg/kg)

D. Give a 500 mL bolus of lactated Ringer’s solution

Correct! Wrong!

Question of the Month - October 2025

Question of the Month – September 2025

A 7-year-old girl, born with microtia (grade III), undergoes an external ear reconstructive surgery. The cartilage for the reconstruction is harvested from 5th to 7th costal cartilages of the right side. Her past medical history is significant for developmental delay and moderate obstructive sleep apnea. For intraoperative pain management, IV ibuprofen and acetaminophen is used. After an uneventful intraoperative period, the patient is transferred to the postoperative area. Two hours later, she begins to experience significant pain over the donor site. She is crying inconsolably and is unable to move. The pain is worsened with deep inspiration. The family has a history of substance use disorder and is very concerned about the use of opioids. Which of the following is most likely the best approach for managing pain in this child?

A. Start continuous intravenous morphine

B. Regional anesthesia with ultrasound-guided External Oblique Intercostal Block (EOIB) + Serratus Anterior Plane Block (SAPB)

C. Oral Tramadol as needed

D. Use a patient-controlled analgesia (PCA) pump

Correct! Wrong!

Question of the Month - September 2025

Question of the Month – August 2025

A 16-year-old patient presents with a history of severe pain in her R leg that persists several months after twisting her ankle during basketball. She reports pain in her right foot without allodynia, hyperalgesia, temperature or skin changes, but with significant swelling and motor impairment. She is walking with a crutch as she is unable to weight-bear on her right leg. She is seen by the multidisciplinary pain clinic and undergoes a unilateral lumbar sympathetic block under general anesthesia. After receiving the block and waking up from anesthesia, her pain is resolved, but now she states that she can’t feel or move either of her legs. She gets an MRI, is evaluated by neurology, and is diagnosed with Functional Neurological Symptom Disorder. What is the definition of FNSD and how might you describe it to a patient?

A. This is a condition in which there is no easily identifiable structural damage where communication between the brain and the body is disrupted resulting in motor, sensory, or cognitive symptoms that are real, but not dangerous in the sense they do not come from acute damage or disease

B. This is another name for conversion disorder, which is a physical manifestation of psychological or emotional distress

C. This is a diagnosis of exclusion, where symptoms are present that cannot be explained by any other diagnosis

D. When a person changes their behavior or demonstrates symptoms purposefully for secondary gain

E. All of the above

Correct! Wrong!

Question of the Month - August 2025

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Question of the Month – December 2025

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