Society for Pediatric Pain Medicine
Better Care for Children in Pain

The Society for Pediatric Pain Medicine (SPPM) aims to advance the quality of anesthesia care and the alleviation of pain-related conditions in children.

Society for Pediatric
Pain Medicine

Better Care for Children in Pain

Question of the Month – November 2023

A 3-month-old infant undergoes a Kasai procedure for biliary atresia. An epidural catheter was threaded from the caudal space to the thoracic level, and the position was confirmed by an epidurogram. On post-op day #1 the bedside nurse states that they do not think the epidural is working because the baby cries intermittently and sometimes appears uncomfortable. FLACC scores have been between 0-6. The baby has an NG tube in place, a right radial arterial line, and 2 peripheral IVs in the upper extremities.

Which of the following techniques is best for determining whether the epidural is functional or not?

A. Confirm the position of the epidural with Ultrasound

B. Use the Wong-Baker Faces Pain Scale in place of the FLACC

C. Check dermatome levels by gently palpating along the chest and abdomen

D. Stop the epidural and look for increased pain behavior

Correct! Wrong!

Question of the Month - November 2023

Question of the Month – October 2023

A 66 kg 15-year-old male with a history of sickle cell disease on methadone maintenance therapy for back pain and adolescent idiopathic scoliosis presents for posterior spinal fusion with combination general and regional anesthesia. Which of the following characteristics may increase the likelihood of developing chronic post-surgical pain (CPSP) in this child?

A. Male patient

B. History of pre-operative pain

C. Undergoing orthopedic surgery versus thoracic surgery

D. Use of a regional anesthetic technique

Correct! Wrong!

Question of the Month - October 2023

Question of the Month – September 2023

A 16-year-old female with chronic migraine without aura comes to your clinic with her mother. She is having 2-3 migraines a week, but her mother notes she has milder headaches a couple of days a week as well. She is missing school frequently and has stopped participating in band. The patient has tried cyproheptadine and amitriptyline as preventive medications with naproxen as an abortive medication. She has not seen a decrease in the number of her monthly headaches, and the naproxen has been helpful, but it does not relieve the migraine. They received a few samples of rimegepant from their PCP, but their insurance company is not going to cover it. Despite her willingness to try off-label medications prior, now her mother is only interested in trying treatments that are FDA approved for pediatrics.

Which of the following preventive and abortive treatment combinations should you consider for this adolescent?

A.) OnabotulinumtoxinA injections and eletriptan

B.) Topiramate and almotriptan

C.) Fremanezumab and sumatriptan

D.) Amitriptyline and rizatriptan

Correct! Wrong!

Question of the Month - September 2023

Question of the Month – August 2023

A 16-year-old male athlete with pectus excavatum is scheduled in the OR for Nuss repair.1 He has previously had general anesthesia at the age of 14, with postoperative nausea and vomiting (PONV) secondary to anesthesia and also post-operative opioids (both intravenous and enteral). Family is requesting a modified anesthetic plan to address his PONV, while also being concerned of the severe pain associated with this procedure. Which plan would be most effective for this patient, to avoid PONV, manage pain efficiently and minimize hospital length of stay?

a) Standardized intraoperative PONV prophylaxis with at least 3 pharmacological agents

b) Minimal intraoperative opioids, and postoperative patient-controlled analgesia (PCA) per standard protocol

c) Total intravenous anesthesia (TIVA) to avoid use of sevoflurane/desflurane

d) Thoracic epidural analgesia

e) Cryoanalgesia performed intraoperatively by surgical team

Correct! Wrong!

Question of the Month - August 2023

Question of the Month – July 2023

A 16-year-old male basketball player arrives at the clinic with chronic bilateral lower leg pain. He reports a sharp cramping pain that begins while running and resolves 10-20 minutes after he stops exercising. He reports occasional paresthesias, and numbness to the extremity. He also reports mild swelling and tightness in both legs only during exercise. He denies any known trauma to the extremity. Physical exam is unremarkable.

What is the best initial treatment for the underlying cause of this patient’s condition?

A. Opioids

B. NSAIDS

C. Modifying/decreasing athletic activity

D. Popliteal nerve block

Correct! Wrong!

Question of the Month - July 2023

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