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. 2023 Jun 1;6(6):e2317200.
doi: 10.1001/jamanetworkopen.2023.17200.

Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception

Naveen Poonai  1 , Daniel M Cohen  2 , Doug MacDowell  2 , Rakesh D Mistry  3 , Santiago Mintegi  4 , Simon Craig  5 , Damian Roland  6   7 , Michael Miller  1 , Itai Shavit  8 ; Paediatric Emergency Research Networks (PERN) PAINT Study Group; Yvette Wang  9 , Alan Nager  10 , Theodore Heyming  11 , Rebekah Burns  12 , Indi Trehan  12 , Matthew Lipshaw  13 , Carmen Sulton  14 , Joyce Li  15 , Aderonke Ojo  16 , Susan Kelly  17 , Matthew Thornton  18 , Kerry Caperell  19 , Iluonose Amoni  20 , Anna Abrams  21 , Myto Duong  22 , Muhammad Wassem  23 , Adrienne Davis  24 , Jocelyn Gravel  25 , Evelyne Doyon Trottier  25 , Neta Bar Am  25 , Graham Thompson  25 , Vikram Sabhaney  26 , Garth Meckler  26 , Rini Jain  27 , Samina Ali  28 , Silvia Bressan  29 , Tiziana Zangardi  29 , Giovanna Villa  30 , Martina Giacalone  31 , Michelle Seiler  32 , Cyril Sahyoun  33 , Fabrizio Romano  34 , Zsolt Bognar  35 , Szofia Hajosi-Kalcakosz  35 , Lisa Amir  36 , Said Hachimi-Idrissi  37 , Zanda Pucuka  38 , Astra Zviedre  38 , Emilija Zeltina  38 , Natalie Phillips  39 , Meredith Borland  40 , Sharon O'Brien  40 , Jeanette Marchant  41 , Amit Kochar  42 , Shane George  43 , Victoria Pennington  44 , Mark Lyttle  45 , Jen Browning  46 , Anna McLoughlin  47 , Stuart Hartshorn  48 , Chaman Urooj  49 , Lucy Johnston  49 , Emily Walton  50 , Deepika Subrahmanyam Puthucode  51 , Phil Peacock  52 , James Conroy  53 , Rafael Marañon  54 , Silvia Garcia  55 , Nuria Cahís  56 , Amaia Cámara-Otegui  57 , Arantxa Gomez  58 , Maria Carbonero  59 , Carlos Angelats-Romero  60 , Adriana Yock-Corrales  61 , Gabriela Hualde  62 , Fabian Spigariol  63 , Alex Donas  64 , Cinthia Gübeli Linné  65 , Alessia Rocchi  66 , Alessia Pedrazzini  67 , Giorgio Cozzi  68 , Dino Barbi  68 , Laura Baggio  69 , Giovana La Fauci  69 , Angela Mauro  70 , Matthew Steimle  71 , Danilo Buonsenso  72 , Irma Ugalde  73 , Gaby Nieva  42 , Charlotte Harper  50 , Idanna Sforzi  31 , Shobhit Jain  74
Collaborators, Affiliations

Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception

Naveen Poonai et al. JAMA Netw Open. .

Erratum in

  • Errors in Byline.
    [No authors listed] [No authors listed] JAMA Netw Open. 2024 May 1;7(5):e2414085. doi: 10.1001/jamanetworkopen.2024.14085. JAMA Netw Open. 2024. PMID: 38691366 Free PMC article. No abstract available.

Abstract

Importance: Ileocolic intussusception is an important cause of intestinal obstruction in children. Reduction of ileocolic intussusception using air or fluid enema is the standard of care. This likely distressing procedure is usually performed without sedation or analgesia, but practice variation exists.

Objective: To characterize the prevalence of opioid analgesia and sedation and assess their association with intestinal perforation and failed reduction.

Design, setting, and participants: This cross-sectional study reviewed medical records of children aged 4 to 48 months with attempted reduction of ileocolic intussusception at 86 pediatric tertiary care institutions in 14 countries from January 2017 to December 2019. Of 3555 eligible medical records, 352 were excluded, and 3203 medical records were eligible. Data were analyzed in August 2022.

Exposures: Reduction of ileocolic intussusception.

Main outcomes and measures: The primary outcomes were opioid analgesia within 120 minutes of reduction based on the therapeutic window of IV morphine and sedation immediately before reduction of intussusception.

Results: We included 3203 patients (median [IQR] age, 17 [9-27] months; 2054 of 3203 [64.1%] males). Opioid use was documented in 395 of 3134 patients (12.6%), sedation 334 of 3161 patients (10.6%), and opioids plus sedation in 178 of 3134 patients (5.7%). Perforation was uncommon and occurred in 13 of 3203 patients (0.4%). In the unadjusted analysis, opioids plus sedation (odds ratio [OR], 5.92; 95% CI, 1.28-27.42; P = .02) and a greater number of reduction attempts (OR, 1.48; 95% CI, 1.03-2.11; P = .03) were significantly associated with perforation. In the adjusted analysis, neither of these covariates remained significant. Reductions were successful in 2700 of 3184 attempts (84.8%). In the unadjusted analysis, younger age, no pain assessment at triage, opioids, longer duration of symptoms, hydrostatic enema, and gastrointestinal anomaly were significantly associated with failed reduction. In the adjusted analysis, only younger age (OR, 1.05 per month; 95% CI, 1.03-1.06 per month; P < .001), shorter duration of symptoms (OR, 0.96 per hour; 95% CI, 0.94-0.99 per hour; P = .002), and gastrointestinal anomaly (OR, 6.50; 95% CI, 2.04-20.64; P = .002) remained significant.

Conclusions and relevance: This cross-sectional study of pediatric ileocolic intussusception found that more than two-thirds of patients received neither analgesia nor sedation. Neither was associated with intestinal perforation or failed reduction, challenging the widespread practice of withholding analgesia and sedation for reduction of ileocolic intussusception in children.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Flow Diagram of Medical Records Reviewed
See this image and copyright information in PMC

References

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