61 Analgesia and sedation for pediatric ileocolic intussusception: a global, multicenter, cross-sectional study (PAINT)
Authors: Poonai Naveen , Cohen Daniel M , MacDowell Doug , Mistry Rakesh , Craig Simon , Ali Samina , Thompson Graham , Roland Damian , Gravel Jocelyn , Sabhaney Vikram , Meckler Garth , Jain Rini , Miller Michael , Davis Adrienne , Shavit Itai , Mintegi Sa 
Published: October 2022

Abstract

Background
Ileocolic intussusception requires timely reduction to prevent complications. Reduction can be distressing. Sedation is uncommon due to controversial beliefs surrounding an increased risk of perforation. Analgesia and sedation practices for children undergoing reduction of intussusception remain largely unknown.

Objectives
To characterize global practice patterns of analgesia and sedation for reduction of intussusception.

Design/Methods
We conducted a global, cross-sectional study involving 84 centres in 14 countries. We included children 4 to 48 months with a sonographic or radiographic diagnosis of ileocolic intussusception and attempted reduction between January 1, 2017, and December 31, 2019. The primary and secondary outcomes were analgesia and sedation, respectively, prior to reduction. An a priori explanatory analysis was performed to explore the association of sedation with (i) adverse events, (ii) perforation, and (iii) failed reduction.

Results
We included 3203 children [2054/3203 (64.1%)] males, with median (IQR) age of 17 (9,27) months. Suspected abdominal pain was present in 2283/3187 (71.6%) children. At triage, a pain assessment tool was documented in 1859/3112 (59.7%) and analgesia was administered to 305/3171 (9.6%) children. After triage, pain was reassessed in 1448/3169 (45.7%) and analgesia was administered to 552/3158 (17.5%) children. Prior to reduction, 550/3161 (17.4%) children were sedated. Non-opioid and opioid analgesia were administered to 183/2945 (6.2%) and 560/3134 (17.9%), respectively. Reduction was performed using air enema in 2372/3184 (74.5%) children and 2700/3184 (84.8%) of all reductions were successful. Reduction related adverse events [65/3166 (2.1%)] were reported in 59 patients, most commonly vomiting [31/3166 (1.0%)] and perforation [13/3166 (0.4%)]. In the bivariate analyses, sedation was not associated with an increased odds of adverse events [OR: 1.1; 95% CI: 0.6-2.1; p=0.79] or perforation [OR: 2.1; 95% CI: 0.7-6.9; p=0.21]. Sedation was associated with an increased odds of failed reduction [OR: 1.4; 95% CI: 1.1-1.7; p=0.01], but this became non-significant in the multivariable analysis [OR: 1.1; 95% CI: 0.8-1.6; p=0.53] after adjusting for age and premorbid gastrointestinal anomaly.

Conclusion
Although more than 2/3 of children with intussusception present with pain, less than 10% were administered analgesia at triage. Prior to reduction, analgesia or sedation was administered to less than 1/5 of children. Adverse events, including perforation were uncommon. Sedation was not associated with adverse events or an increased odds of failed reduction in the adjusted analysis. Our findings suggest that analgesia should be considered in children with suspected abdominal pain and sedation should be routinely considered for children undergoing reduction of intussusception.