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 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 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 17-year-old girl presents to your chronic pain clinic with neuropathic pain of her right leg secondary to osteosarcoma of the right femur. She has severe persistent neuropathic pain despite treatment with pregabalin, duloxetine, physiotherapy, and psychological treatments. The teen and her parents are interested in exploring cannabinoids for treatment of her pain and want to discuss this further with you. Which one of the following statements is incorrect?
A 9-year-old female child presents to your clinic with complaints of right ankle pain after having a sprain 9 months ago when she fell during a soccer game. Mother states that the child’s foot often turns reddish purple, and is extremely painful. Since the injury she will only wear sandals as socks or shoes are intolerable. Exam reveals allodynia and hyperalgesia with color and temperature changes involving the dorsal and ventral aspect of the right foot.
After comprehensive consultation with the family and negative work up for any red flags please choose the correct answer. Which of the following is correct?