Question of the Month Archives - Society for Pediatric Pain Medicine

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

Question of the Month – July 2025

A 15-year-old boy is undergoing an ACL reconstruction. He is otherwise healthy and has no relevant past medical history.

Which of the following block combinations is most likely to provide the most complete analgesia with minimal motor weakness?

A. Femoral nerve block + sciatic block in popliteal fossa

B. Adductor canal block + anterior sciatic nerve block

C. Adductor canal block + IPACK

D. Adductor canal block + anterior femoral cutaneous nerve block

Correct! Wrong!

Question of the Month - July 2025

Question of the Month – June 2025

A 12‑year‑old male with a known history of congenital methemoglobinemia presents for bilateral inferior alveolar nerve blocks to facilitate extraction of multiple impacted molars. He has no prior anesthetic history and is otherwise healthy. His preoperative hemoglobin is 14.6 g/dL, and his baseline methemoglobin level ranges from 2 % to 14 %. Which of the following is the most appropriate anesthetic management strategy for this patient?

A. Proceed with bilateral inferior alveolar nerve blocks using 4 % prilocaine with epinephrine, without additional monitoring.

B. Avoid all local anesthetics and use GA with volatile anesthetics.

C. Perform the nerve blocks under ultrasound guidance using ropivacaine, implement continuous or serial methemoglobin monitoring, and have methylene blue immediately available.

D. Use topical benzocaine spray to supplement a single-shot inferior alveolar block to minimize injection volume.

Correct! Wrong!

Question of the Month - June 2025

Question of the Month – May 2025

A 7-year-old boy (24 kg) undergoes extensive bilateral lower-extremity orthopedic surgery. Epidural catheter placement under general anesthesia proves technically difficult, requiring several needle passes before a catheter is threaded. Twenty-four hours later he develops a bifrontal, throbbing headache with vomiting that is immediately relieved when supine and recurs on sitting or standing. Conservative therapy—including IV fluids, oral caffeine citrate, acetaminophen, ketorolac, and continuation of the local anesthetic infusion through the catheter—fails to provide durable relief. The parents are hesitant about further neuraxial procedures and ask whether any less-invasive options exist before proceeding to an epidural blood patch.

Which of the following interventions has documented success in children for aborting PDPH:

A. Bilateral greater-occipital-nerve blocks with 0.25 % bupivacaine

B. Intravenous cosyntropin (synthetic ACTH) 1 µg kg⁻¹ infused over 5 min

C. Trans-nasal sphenopalatine-ganglion (SPG) block using 4 % lidocaine-soaked applicator

D. Epidural saline bolus via the existing catheter

Correct! Wrong!

Question of the Month - May 2025

Question of the Month – April 2025

A 16‐year‐old patient undergoing an open laparotomy had a T12 epidural placed under standard sterile technique. Because the “loss‐of‐resistance” was not crisp and the resident expressed doubt about catheter placement. In addition to the usual epidural test dose of epinephrine, which of the following published methods can help confirm correct epidural catheter placement in pediatric patients?

Options:

A. Epidural Pressure Waveform Analysis

B. Electrical Stimulation (Tsui Test)

C. Fluoroscopic Guidance with Contrast Injection (Epidurography)

D. Ultrasound Confirmation

E. pH Testing of Aspirated Fluid

F. Combined Spinal-Epidural (CSE) Technique

a. A, B, and C

b. A, E, and F

c. B, C, and D

d. All of the above

Correct! Wrong!

Question of the Month - April 2025

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Question of the Month – August 2025

Question of the Month – July 2025

A 15-year-old boy is undergoing an ACL reconstruction. He is otherwise healthy and has no relevant past medical history.

Which of the following block combinations is most likely to provide the most complete analgesia with minimal motor weakness?

Question of the Month – June 2025

Question of the Month – May 2025

Question of the Month – April 2025

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A 15-year-old boy is undergoing an ACL reconstruction. He is otherwise healthy and has no relevant past medical history. Which of the following block combinations is most likely to provide the most complete analgesia with minimal motor weakness?

Upcoming Meeting Information

A 15-year-old boy is undergoing an ACL reconstruction. He is otherwise healthy and has no relevant past medical history.

Which of the following block combinations is most likely to provide the most complete analgesia with minimal motor weakness?