Society for Pediatric Pain Medicine
Better Care for Children in Pain.

A 6-year-old boy undergoes an open reduction and internal fixation (ORIF) of the distal radius and ulna. An ultrasound-guided supraclavicular brachial plexus block is placed with 8 mL of 0.25% bupivacaine before incision; intraoperative analgesia consists of fentanyl 1 mcg/kg and intravenous (IV) acetaminophen 15 mg/kg. He is discharged home two hours later after an uneventful recovery in the post-anesthesia care unit (PACU) with scheduled oral acetaminophen and as-needed oxycodone. At 18 hours postoperatively, his parents called the on-call line, reporting that he was inconsolable, guarding his arm, and rating his pain as "the worst it has ever been." He has not yet received any oxycodone.