Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Sep 2;8(9):e2533584.
doi: 10.1001/jamanetworkopen.2025.33584.

Opioid Administration and Reduction of Pediatric Ileocolic Intussusception

Karina Burke  1 , Itai Shavit  2 , Daniel M Cohen  3 , Doug MacDowell  3 , Rakesh D Mistry  4 , Santiago Mintegi  5 , Simon Craig  6 , Damian Roland  7   8 , Michael R Miller  9 , Samina Ali  10 , Naveen Poonai  1   9 ; Pediatric Emergency Research Networks (PERN) PAINT Study Group
Collaborators, Affiliations
Multicenter Study

Opioid Administration and Reduction of Pediatric Ileocolic Intussusception

Karina Burke et al. JAMA Netw Open. .

Abstract

Importance: Ileocolic intussusception is an important and painful cause of bowel obstruction in children. Its reduction is also painful, but neither sedation nor analgesia is routinely provided, in part due to concerns surrounding gastrointestinal slowing and consequent failed reduction, and while fentanyl is a potent analgesic, little is known about its association with failed reduction.

Objective: To investigate whether fentanyl is associated with failed reduction in children with intussusception.

Design, setting, and participants: This was a secondary analysis of a cross-sectional study from 86 pediatric tertiary care centers in 14 countries conducted between January 1, 2017, and December 31, 2019, characterizing the association of opioid analgesia and sedation with intestinal perforation and failed reduction in children. A consecutive sample of patients 4 to 48 months of age with a discharge diagnosis of ileocolic intussusception who underwent an attempted reduction of intussusception was analyzed, excluding repeat presentations of intussusception and records lacking data for the primary outcome.

Main outcome and measures: Age, sex, preexisting gastrointestinal anomalies, time to reduction, and use of prereduction opioid medication data were collected. The primary outcome was the percentage of patients with failed reduction of ileocolic intussusception. Bivariate and multivariable analyses were conducted to determine the association between fentanyl and failed reduction. Data were analyzed in February 2025.

Results: In total, 3184 patients (2038 [64.01%] male), with a median (IQR) age of 17 (9-27) months, were included. Fentanyl was administered within 120 minutes of attempted reduction for 116 of 3167 patients (3.66%). Failed reduction occurred in 484 of 3184 patients (15.20%). In the unadjusted analysis, fentanyl was not associated with failed reduction (odds ratio [OR], 0.66 [95% CI, 0.36-1.22]). In the adjusted analysis, preexisting gastrointestinal anomalies (OR, 4.38 [95% CI, 1.50-12.76]), longer triage to reduction time (OR, 1.04 [95% CI, 1.01-1.07]), and younger age (OR, 0.96 [95% CI, 0.95-0.97]) were associated with failed reduction.

Conclusions and relevance: In this cross-sectional study of pediatric ileocolic intussusception, fentanyl administration prior to attempted reduction was not associated with failed reduction. These results suggest that fentanyl may be considered a safe therapeutic option to manage children's intussusception and subsequent reduction-related pain.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Ali reported volunteering on the scientific advisory board for the National Pain Advisory Council (Washington, DC) outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Flow Diagram of Medical Records Reviewed
Some records were excluded for more than 1 reason.
See this image and copyright information in PMC

References

    1. Kim PH, Hwang J, Yoon HM, et al. Predictors of failed enema reduction in children with intussusception: a systematic review and meta-analysis. Eur Radiol. 2021;31(11):8081-8097. doi: 10.1007/s00330-021-07935-5 - DOI - PubMed
    1. Khorana J, Sayuen C, Chanaturakarnnon S, et al. Temporal validation of Chiang Mai University intussusception failed reduction score (CMUI). Int J Environ Res Public Health. 2022;19(9):5289. doi: 10.3390/ijerph19095289 - DOI - PMC - PubMed
    1. Huang HY, Lin XK, Guo SK, et al. Haemostatic indexes for predicting intestinal necrosis in children with intussusception. ANZ J Surg. 2021;91(7-8):1485-1490. doi: 10.1111/ans.16854 - DOI - PubMed
    1. Wondemagegnehu BD, Kerego EN, Mammo TN, Robele AT, Gebru FT, Aklilu WK. Predictors of failure in ultrasound-guided hydrostatic reduction of intussusception in children: retrospective analysis in a specialized center in Ethiopia. Pediatric Health Med Ther. 2024;15:87-94. doi: 10.2147/PHMT.S451832 - DOI - PMC - PubMed
    1. Shah JY, Banday I, Hamdani HZ, et al. A study of predictors of failure of nonoperative management of ileocolic intussusception in children. Euroasian J Hepatogastroenterol. 2024;14(1):81-85. - PMC - PubMed

Publication types