Society for Pediatric Pain Medicine
Better Care for Children in Pain

SEPTEMBER 2025 QUESTION OF THE MONTH
Question Authors:  Umanga Luintel, MBBS 4th Year, KIST Medical College and Teaching Hospital and RJ Ramamurthi, MD, Clinical Professor, Stanford University
Question Editor:  Rita Agarwal, MD, FAAP, Clinical Professor, Stanford University

A 7-year-old girl, born with microtia (grade III), undergoes an external ear reconstructive surgery. The cartilage for the reconstruction is harvested from 5^th to 7^th 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

Answer the Question

AUGUST 2025 VISUAL PEARL
Visual Pearl Contributors:  Alvina Rosales, PhD, Children’s Hospital Los Angeles; Elysia Soria, PhD, Children’s Hospital Los Angeles; Abid Haque, MD
Visual Pearl Editor: Genevieve D’souza, MD, FASA, Stanford University School of Medicine