SPPM has updated our trainee section with a list of all available fellowship training opportunities in pediatric acute pain and regional anesthesia. Please click HERE for the Pediatric Acute Pain/Regional Anesthesia Fellowship Programs and click HERE for the Pediatric Chronic Pain Fellowship Programs.
Question of the Month
A 16-year old male with sickle cell disease presents to the hospital in acute pain crisis. His sickle cell disease has worsened over the last few years, and optimal pain control during acute crises has been difficult to achieve. His analgesic regimen is complex and includes non-pharmacological methods (e.g. distraction techniques, behavioral modification therapy) as well as acetaminophen, NSAIDs, hydromorphone, methadone, and most recently, initiation of a lidocaine infusion. He reports low pain scores on the intravenous lidocaine and wonders if he can continue lidocaine in some form as an outpatient. The patient’s care team suggests transition to oral mexiletine as a replacement for intravenous lidocaine. Which of the following is false?
A) Most patients should experience a significant decrease in pain scores with a dose of 450 mg/day.
B) Total dose of mexiletine should be decreased in liver or kidney failure.
C) Mexiletine can be discontinued without tapering.
D) Patients who do not respond adequately to intravenous lidocaine infusion are unlikely to respond well to oral mexiletine treatment.