Question of the Month - January 2018 - Society for Pediatric Pain Medicine

A 2.5 month-old, ex- 31 week premature infant is scheduled for an exploratory laparotomy for adhesiolysis and possible small bowel resection. The infant has a history of necrotizing enterocolitis, and underwent a small bowel resection six weeks prior to the operation. Other history includes grade I IVH. The infant was intubated for 3 weeks after birth, and for one week following her initial operation. She required significant amounts of opioid for sedation during mechanical ventilation, and recently finished weaning opioids. The surgeon requests epidural placement to facilitate immediate postoperative extubation and minimize postoperative opioids.
Preoperative lab results include an INR of 1.3 (normalized values 0.8-1.2), PTT of 45.4 (normal 28-37 seconds), fibrinogen 175 mg/dL (normal 200-400), platelets 375 K/uL.

What strategy would you select for postoperative pain management?

A. Epidural (thoracic or caudal-to-thoracic) placement with local anesthetic infusion

B. Continuous Morphine infusion

C. PRN intravenous morphine

D. Single-shot Paravertebral Block

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Question of the Month – January 2018

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