We conclude that the administration of ketamine 0.5 mg·kg(-1) with 1 mcg·kg(-1) fentanyl in children undergoing tonsillectomy may improve postoperative pain control without delaying home discharge.

of poor medication compliance, the presence of recurrent VTE on enoxaparin therapy and the mechanism of dabigatran to inhibit clot bound thrombin. There is little data regarding the treatment of refractory, recurrent VTE and even less data for the treatment of dabigatran in pediatric patients. The patient received two months of dabigatran before being readmitted secondary to increasing chest pain and shortness of breath secondary, with an ECHO showing a slight increase in the previous right arterial clot. Though absolute medication compliance could not be guaranteed, the patient had regular follow up and was thought to have been compliant with her anticoagulation regimen. She was then transitioned to rivaroxaban due to worsening dyspnea on dabigatran and continues oral factor Xa inhibitor therapy at this time. Additional data are needed regarding use of newer anticoagulant therapies in the pediatric population, especially in those with recurrent, treatment refractory VTE.

A 46-year-old woman presented with pain in the lateral side of the left chest wall and a sensation of fullness and pulling in the epigastric region, which started 4 weeks following diaphragmatic plication for left diaphragmatic eventration. The patient was diagnosed as suffering from post-thoracotomy pain syndrome (PTPS). A diagnostic intercostal nerve block relieved the chest wall pain, but not the epigastric pain. After a detailed evaluation, the epigastric pain was postulated to be of diaphragmatic origin and hence a diagnostic phrenic nerve block was performed which relieved the epigastric pain. Combined intercostal nerve neurolysis and phrenic nerve block relieved her pain completely. The phrenic nerve may play a role in pain transmission and the genesis of chronic pain following diaphragmatic surgery. Diaphragmatic pain following surgery may contribute to the development of chronic pain. Phrenic nerve blockade provides diagnostic information regarding the etiology of pain as well as being effective in providing analgesia. The technique of phrenic nerve block is presented and its role in the diagnosis and treatment of pain following thoracic surgery is reviewed.