Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception
Authors: Poonai Naveen , Cohen Daniel M. , MacDowell Doug , Mistry Rakesh D. , Mintegi Santiago , Craig Simon , Roland Damian , Miller Michael , Shavit Itai ,   Paediatric Emergency Research Networks (PERN) PAINT Study Group, Patel Nishit , Gutierrez Camilo , Roben Emily , Pruitt Chris , Quayle Kimberly S. , Rolin Alicia , Kornfeld Dan , Davis Justin , Grupp-Phelan Jackie , Bogie Amanda , Territo Heather , Hershman Eli , Kolbergs Jānis , Stanton Virginia , Sheedy Sarah , Forester Steve , Binham Liz , Dell’Era Laura , Tornesello Assunta , Wang Yvette , Nager Alan , Heyming Theodore , Burns Rebekah , Trehan Indi , Lipshaw Matthew , Sulton Carmen , Li Joyce , Ojo Aderonke , Kelly Susan , Thornton Matthew , Caperell Kerry , Amoni Iluonose , Abrams Anna , Duong Myto , Wassem Muhammad , Davis Adrienne , Gravel Jocelyn , Doyon Trottier Evelyne , Bar Am Neta , Thompson Graham , Sabhaney Vikram , Meckler Garth , Jain Rini , Ali Samina , Bressan Silvia , Zangardi Tiziana , Villa Giovanna , Giacalone Martina , Seiler Michelle , Sahyoun Cyril , Romano Fabrizio , Bognar Zsolt , Hajosi-Kalcakosz Szofia , Amir Lisa , Hachimi-Idrissi Said , Pucuka Zanda , Zviedre Astra , Zeltiņa Emīlija , Phillips Natalie , Borland Meredith , O'Brien Sharon , Marchant Jeanette , Kochar Amit , George Shane , Pennington Victoria , Lyttle Mark , Browning Jen , McLoughlin Anna , Hartshorn Stuart , Urooj Chaman , Johnston Lucy , Walton Emily , Subrahmanyam Puthucode Deepika , Peacock Phil , Conroy James , Marañon Rafael , Garcia Silvia , Cahís Nuria , Cámara-Otegui Amaia , Gomez Arantxa , Carbonero Maria , Angelats-Romero Carlos , Yock-Corrales Adriana , Hualde Gabriela , Spigariol Fabian , Donas Alex , Gübeli Linné Cinthia , Rocchi Alessia , Pedrazzini Alessia , Cozzi Giorgio , Barbi Dino , Baggio Laura , La Fauci Giovana , Mauro Angela , Steimle Matthew , Buonsenso Danilo , Ugalde Irma , Nieva Gaby , Harper Charlotte , Sforzi Idanna , Jain Shobhit 
Published: June 2023

ImportanceIleocolic 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.ObjectiveTo characterize the prevalence of opioid analgesia and sedation and assess their association with intestinal perforation and failed reduction.Design, Setting, and ParticipantsThis 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.ExposuresReduction of ileocolic intussusception.Main outcomes and measuresThe 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.ResultsWe 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 &amp;lt; .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 RelevanceThis 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.