Evaluating Fentanyl Use in Pediatric Ileocolic Intussusception Reduction: Implications for Pain Management and Success Rates

Highlight

• Fentanyl administration prior to attempted reduction in pediatric ileocolic intussusception was not linked to increased failure rates.
• Preexisting gastrointestinal anomalies, prolonged time from triage to reduction, and younger age were associated with failed reduction.
• These findings suggest fentanyl is a viable analgesic option to improve pain management during intussusception reduction without compromising procedural success.

Study Background

Ileocolic intussusception represents a common cause of bowel obstruction in children aged between 4 and 48 months. This condition occurs when a proximal segment of the intestine telescopes into a distal segment, causing obstruction and ischemia. Its management involves reduction, often by pneumatic or hydrostatic enema under imaging guidance. However, the reduction procedure itself can be painful. Despite this, sedation and analgesia are not routinely administered in many centers, partly due to concerns that opioids such as fentanyl might decrease intestinal motility, potentially leading to unsuccessful reductions or an increased risk of perforation.

Given the potent analgesic efficacy of fentanyl and limited data addressing its safety and effects on reduction outcomes, this study aimed to investigate the association between fentanyl use and failed reduction in children undergoing attempted reduction for ileocolic intussusception.

Study Design

This secondary analysis leveraged data from a cross-sectional study conducted across 86 pediatric tertiary care centers in 14 countries from 2017 to 2019. The study population included a consecutive sample of children aged 4 to 48 months diagnosed with ileocolic intussusception who underwent an attempted reduction procedure. Repeat presentations and records with incomplete data for the primary outcome were excluded.

Key variables collected included demographic data (age, sex), clinical factors (presence of preexisting gastrointestinal anomalies), timing from triage to reduction, and administration of opioid analgesia within 120 minutes preceding the procedure. The primary endpoint assessed was the rate of failed reduction of ileocolic intussusception.

Statistical analyses comprised both bivariate and multivariable logistic regression to identify associations between fentanyl administration and failed reduction, adjusting for potential confounders.

Key Findings

A total of 3,184 patients were analyzed, median age 17 months, predominantly male (64.01%). Fentanyl was administered within 2 hours of attempted reduction in 116 patients (3.66%). Overall failed reduction rate was 15.20% (484/3,184).

In unadjusted analysis, fentanyl use was associated with a non-significant reduction in odds of failed reduction (OR 0.66; 95% CI, 0.36–1.22). After adjusting for confounders including age, preexisting gastrointestinal anomalies, and time to reduction, fentanyl administration remained not significantly associated with failed reduction.

Significant independent predictors of failed reduction were:

• Preexisting gastrointestinal anomalies (OR 4.38; 95% CI, 1.50–12.76)
• Longer duration from triage to reduction (OR 1.04 per minute; 95% CI, 1.01–1.07)
• Younger patient age (OR 0.96 per month increase in age; 95% CI, 0.95–0.97)

These findings reinforce established risk factors while suggesting opioid analgesia with fentanyl does not adversely affect procedural success rates.

Expert Commentary

This extensive multicenter study addresses an important clinical dilemma: balancing effective pain control against procedural risks in pediatric intussusception reduction. The absence of an association between fentanyl administration and failed reduction provides reassuring evidence favoring the safe use of fentanyl for analgesia in this setting.

Pediatric intussusception reduction has historically been performed without sedation or analgesia due to concerns about gastrointestinal motility suppression and perforation risk. However, untreated pain can cause significant distress and may complicate procedural cooperation. Given fentanyl’s rapid onset, titratable dosing, and favorable safety profile, its use can facilitate humane care without compromising outcomes.

Limitations include the observational design and relatively small proportion of patients receiving fentanyl, which may underpower detection of subtle effects. Nonetheless, the multinational scope and large overall sample lend robustness. Further prospective, controlled studies would be valuable to confirm these findings and establish best practice guidelines.

Conclusion

This study provides strong evidence that fentanyl analgesia prior to attempted reduction of pediatric ileocolic intussusception is not associated with increased risk of failed reduction. Incorporating fentanyl into pain management protocols can thus improve patient comfort without negatively impacting procedural success. Clinicians should also remain vigilant regarding known risk factors such as younger age, preexisting gastrointestinal anomalies, and prolonged time to reduction. Improved pain control, combined with timely diagnosis and intervention, may optimize clinical outcomes and experience for affected children.

Funding and Clinical Trials

The study was conducted by the Pediatric Emergency Research Networks (PERN) PAINT Study Group. Funding and trial registration details were provided in the original publication (Burke K et al., JAMA Netw Open. 2025).

References

1. Burke K, Shavit I, Cohen DM, MacDowell D, Mistry RD, Mintegi S, Craig S, Roland D, Miller MR, Ali S, Poonai N; Pediatric Emergency Research Networks (PERN) PAINT Study Group. Opioid Administration and Reduction of Pediatric Ileocolic Intussusception. JAMA Netw Open. 2025 Sep 2;8(9):e2533584. doi:10.1001/jamanetworkopen.2025.33584.
2. Kapoor A, et al. Pain management during pediatric intussusception reduction: a review. Pediatric Emergency Care. 2023;39(2):e210-e215.
3. Trehan RK, et al. Safety and efficacy of sedation and analgesia during intussusception reduction in children. Pediatr Emerg Med J. 2022;39(4):176-182.