Burke Karina, Shavit Itai, Cohen Daniel M, MacDowell Doug, Mistry Rakesh D, Mintegi Santiago, Craig Simon, Roland Damian, Miller Michael R, Ali Samina, Poonai Naveen
Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Department of Paediatrics, Hadassah Hebrew University Hospitals, Jerusalem, Israel.
JAMA Netw Open. 2025 Sep 2;8(9):e2533584. doi: 10.1001/jamanetworkopen.2025.33584.
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.
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.
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.
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.
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.
回结肠套叠是儿童肠梗阻的一个重要且引起疼痛的原因。其复位过程也很痛苦，但常规情况下既不给予镇静也不给予镇痛，部分原因是担心胃肠道蠕动减慢以及随之而来的复位失败，虽然芬太尼是一种强效镇痛药，但对于其与复位失败之间的关联知之甚少。
探讨芬太尼与套叠患儿复位失败是否有关联。
设计、设置和参与者：这是对一项横断面研究的二次分析，该研究来自14个国家的86个儿科三级护理中心，于2017年1月1日至2019年12月31日进行，旨在描述阿片类镇痛和镇静与儿童肠穿孔及复位失败之间的关联。对年龄在4至48个月、出院诊断为回结肠套叠且尝试进行套叠复位的患者连续样本进行分析，排除套叠的重复就诊情况以及缺乏主要结局数据的记录。
收集年龄、性别、既往胃肠道异常情况、复位时间以及复位前阿片类药物使用数据。主要结局是回结肠套叠复位失败患者的百分比。进行双变量和多变量分析以确定芬太尼与复位失败之间的关联。数据于2025年2月进行分析。
总共纳入3184例患者（2038例[64.01%]为男性），中位（四分位间距）年龄为17（9 - 27）个月。在3167例患者中有116例（3.66%）在尝试复位的120分钟内给予了芬太尼。3184例患者中有484例（15.20%）复位失败。在未调整分析中，芬太尼与复位失败无关（比值比[OR]，0.66[95%置信区间，0.36 - 1.22]）。在调整分析中，既往胃肠道异常（OR，4.38[95%置信区间，1.50 - 12.76]）、较长的分诊至复位时间（OR，1.04[95%置信区间，1.01 - 1.07]）以及较年轻的年龄（OR，0.96[95%置信区间，0.95 - 0.97]）与复位失败相关。
在这项关于儿童回结肠套叠的横断面研究中，尝试复位前给予芬太尼与复位失败无关。这些结果表明，芬太尼可被视为管理儿童套叠及随后与复位相关疼痛的一种安全治疗选择。
