Periprocedural analgesia and sedation in air enema reduction for intussusception: A retrospective Australian cohort study

Yeoh, Kenny; Palmer, Greta M; Teague, Warwick J.; Shavit, Itay; Babl, Franz E

doi:10.1111/jpc.15142

Cited by 5 publications

(7 citation statements)

References 18 publications

(35 reference statements)

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“…There have also been no published evaluations of the severity of pain and distress during intussusception. Interestingly, our lower rate of analgesia contrasted with the Yeoh et al sample where 61 of 73 children (83.5%) were administered analgesia prior to reduction. Australian practice patterns may reflect the development of hospital guidelines recommending analgesia as part of general management…”

Section: Discussioncontrasting

confidence: 80%

“…procedure. Nevertheless, we found that neither opioid analgesia nor sedation within 2 hours of reduction was independently associated with perforation, in concert with the findings of Yeoh et al, 20 where opioid analgesia within 2 hours of reduction was provided to 65.8% of Australian children and no perforations were reported.…”

Section: Jama Network Open | Pediatricssupporting

confidence: 85%

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Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception

Poonai,

Cohen,

MacDowell

et al. 2023

JAMA Netw Open

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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 &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.

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Section: Discussioncontrasting

confidence: 80%

Section: Jama Network Open | Pediatricssupporting

confidence: 85%

Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception

Poonai,

Cohen,

MacDowell

et al. 2023

JAMA Netw Open

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“…22,23 Perforation rates were comparable between pneumatic and hydrostatic reduction with most series reporting less than 1%. 9,18 Our study had no procedure related perforation.…”

Section: Discussionmentioning

confidence: 74%

“…Ultrasound guided hydrostatic reduction is a less commonly utilized alternative technique. The success rate of pneumatic reduction and hydrostatic reduction are similar and range from 68% to 90% 7–14 . There are several published comparative studies and randomized controlled trials 5,15–17 comparing pneumatic versus hydrostatic reduction.…”

Section: Discussionmentioning

confidence: 99%

“…The success rate of pneumatic reduction and hydrostatic reduction are similar and range from 68% to 90%. [7][8][9][10][11][12][13][14] There are several published comparative studies and randomized controlled trials 5,[15][16][17] comparing pneumatic versus hydrostatic reduction. Applegate (2009) and Sadigh (2015) concluded that air enema was superior to liquid enema for successful reduction of intussusception in children, 15,17 whereas Daneman (2003) and Ko (2007) concluded that ultrasound-guided reduction was superior to fluoroscopy owing to its greater efficacy and lack of ionizing radiation.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound guided hydrostatic enema reduction of ileocolic intussusception: a safe and effective technique

Binu

Nicholson

Granger

et al. 2023

ANZ Journal of Surgery

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BackgroundCurrently, the primary management of ileocolic intussusception in children is usually by non‐operative image‐guided enema reduction. In most centres around the world especially in Australasia the predominant technique is the pneumatic reduction under fluoroscopic guidance. At our institution, we have been performing ultrasound‐guided hydrostatic reduction since 2012.This is an audit to determine the efficacy and safety of ultrasound‐guided hydrostatic reduction for intussusception.MethodsFollowing ethics approval, a retrospective review of all patients presenting to our institution with intussusception and subsequently undergoing hydrostatic reduction over a period of 9 years (2012 to–2020) was performed. The parameters studied included (i) successful reduction, (ii) recurrence, (iii) need for surgery and (iv) lead point at surgery.ResultsThe mean age at presentation was 12 months. One hundred and eight children were diagnosed to have ileocolic intussusception. One hundred and six underwent ultrasound‐guided hydrostatic reduction with successful reduction in 96 (90.5%) patients. Reduction was unsuccessful in 10 patients (9.5%). Of these eight were noted to have a pathological lead point (four—Meckel's diverticulum and four—Lymphoma) at the time of the surgery. The intussusception recurred in six patients (6.25%) within 24 h. No reduction related perforation occurred during the study period.ConclusionUltrasound‐guided hydrostatic reduction is a safe and effective technique for managing intussusception as it allows continuous monitoring of the reduction of the intussusception without exposing the children to ionizing radiation.

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