Question of the Month Archives - Society for Pediatric Pain Medicine

Question of the Month – June 2023

A 19 year male is on Medication Assisted Treatment (MAT) with Buprenorphine maintenance daily. His current dosage is 6 mg of buprenorphine daily. He is scheduled for a NUSS procedure. As his AYA (Adolescent and Young Adult) Pain Doctor what would you advise the patient about his Buprenorphine perioperatively?

A. It should be increased few days prior to the surgery

B. It should be continued during the perioperative period at the same dose.

C. It should be stopped 48 hrs prior to the surgery

D. It should be stopped 5 days prior to the surgery

Correct! Wrong!

Question of the Month - June 2023

Question of the Month – May 2023

A 14-year-old young woman with joint hypermobility presented with bilateral anterior knee pain. It started after a soccer tournament 3 years ago with initial presenting symptoms of knee pain and subjective swelling. She was initially treated with rest, modified weight bearing with crutches, knee brace and NSAIDs. The swelling improved, but the knee pain and kinesiophobia persisted. The pain significantly increases with any active or passive knee flexion. She maintains the knees in full extension the majority of time even when she sits.

Physical examinations are notable for mild bilateral patellar alta, mild lateral tilt of the patellae, internal rotation of the tibia, mild genu valgum, exquisite tender to palpation at the inferior patellar tendon, positive Hoffa’s fat pad impingement test.

Radiographic images were normal.

Which of the following syndromes is most suggested by the presentation outlined above?

A. Patellofemoral syndrome

B. Plica syndrome

C. Infrapatellar fat pad syndrome

D. Complex regional pain syndrome

Correct! Wrong!

Question of the Month - May 2023

Question of the Month – April 2023

A 5-year-old 16kg male (ex-24 week) with an extensive history of abdominal surgeries is scheduled for another exploratory laparotomy. He has a history of short gut syndrome, osteopenia, and prior multi-level thoracic fractures. He also has a superior mesenteric vein thrombus and left common femoral vein thrombus that is managed on prophylactic enoxaparin BID. Hematology will hold the enoxaparin twelve hours prior to the procedure with the plan to restart postoperatively. His parents are appropriately worried as pain control has been challenging in previous surgeries. The pediatric general surgeon consults you for assistance with post-operative pain management plan after his exploratory laparotomy.

Which of the following is the best regional technique for acute postoperative pain control as an epidural is contra-indicated?

A. Continuous Transversus Abdominis Plane (TAP) block

B. Continuous Quadratus lumborum (QL) block

C. Continuous Erector Spinae Plane block (ESP)

D. Continuous Paravertebral block

Correct! Wrong!

Question of the Month - April 2023

Question of the Month – March 2023

A 14-year-old female with hypermobility type Ehlers Danlos Syndrome (hEDS), Postural Orthostatic Tachycardia Syndrome (POTS) and anxiety is scheduled for right temporal craniotomy for resection of a hippocampal lesion. Her home medications include escitalopram and gabapentin. On the morning of surgery, the patients’ mother presents a laboratory report showing that her daughter and her are CYP2D6 and CYP2C19 extensive metabolizers. Intraoperatively, the patient received propofol, ketamine, rocuronium, cefazolin, levetiracetam, fentanyl, dexamethasone, acetaminophen, granisetron and scopolamine. The case is uneventful, the patient is extubated in the operating room and then brought to the ICU. In addition to restarting her home medications, the ICU team also ordered: dexamethasone, levetiracetam, ondansetron, pantoprazole, acetaminophen and ibuprofen. And hour after arrival to the ICU, she complains of a headache which she rates 9/10 pain, and pain at the surgical site. Which of the following medication is most appropriate to add for postoperative pain management?

A. Codeine-acetaminophen

B. Hydrocodone

C. Morphine

D. Oxycodone

E. Hydromorphone

F. Methadone

Correct! Wrong!

Question of the Month - March 2023

Question of the Month – February 2023

A 17-year-old male patient presents to the OR for emergent right ankle open reduction internal fixation for fracture of the right ankle obtained when playing basketball. The patient has a past medical history of well-controlled asthma, eczema, and seasonal allergies. He also has a history of opioid use disorder that was diagnosed after he was noted to have aberrant behavior in his classroom and his mother found her post-operative oxycodone pill bottle was empty. Six months ago, he was placed on medication for opioid use disorder (MOUD) that included buprenorphine 4 mg sublingual twice per day. Which of the following is NOT a correct statement regarding buprenorphine?

A. Buprenorphine should not be routinely discontinued or tapered in the perioperative setting.

B. Buprenorphine is extensively metabolized by the liver via CYP3A4 with first pass metabolism and has low oral bioavailability.

C. In order for a clinician to prescribe buprenorphine they need to first obtain a DATA-waiver (X-waiver).

D. Buprenorphine is 25-40 times more potent than morphine.

Correct! Wrong!

Question of the Month - February 2023

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