Anesthetic methods for reduction of acute shoulder dislocations: A prospective randomized study comparing intraarticular lidocaine with intravenous analgesia and sedation

Kosnik, Joseph W.; Shamsa, Falah; Raphael, Elizabeth; Huang, Ran; Malachias, Zachary; Georgiadis, Gregory M.

doi:10.1016/s0735-6757(99)90197-3

Cited by 59 publications

(85 citation statements)

References 8 publications

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“…Kosnik and colleagues suggested that if time to treatment was 5.5 hours or greater, more treatment failures were expected in the IAL group. 6 A prolonged dislocation time may lead to increased muscular spasm and pain, yet an intra-articular injection anesthetizes the glenohumeral joint only and does not provide analgesia or relaxation of the surrounding shoulder girdle muscles, which could lead to a decreased success rate. Interestingly, a 2002 study identified insufficient analgesia in 21% of IAL patients, which was not statistically different from 4% in the IVS group, yet all of the reductions were successful in both groups.…”

Section: Discussionmentioning

confidence: 99%

Intra-articular lidocaine versus intravenous sedation for the reduction of anterior shoulder dislocations in the emergency department

Hames

McLeod

Millard

2011

CJEM

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Objective: The objective was to compare intra-articular lidocaine (IAL) versus intravenous sedation (IVS) for the reduction of acute, anterior shoulder dislocations in the emergency department (ED) in terms of ED length of stay, rate of successful reductions, patient satisfaction, and complications. Methods: This was a prospective, randomized trial. Patients in the IAL group received 4 mg/kg (up to 200 mg) of 1% lidocaine injected into the glenohumeral joint using a lateral approach. Patients in the IVS group received medications for sedation as per the discretion of the treating physician. Follow-up was arranged within 2 weeks of the ED visit to assess for complications. Results: Forty-four patients (25 IAL, 19 IVS) were included. This trial was stopped early owing to a combination of unexpected findings in success, resource limitations, and difficulty in patient enrolment. Median time from first physician assessment to patient discharge was not different between the IAL (170 minutes) group and the IVS (145 minutes) group (D 225 minutes; 95% CI 232, 70; p 5 0.46). There was a significantly lower rate (p , 0.001) of successful closed reduction in the IAL group (48%) compared to the IVS group (100%). Patient satisfaction and physician ease of reduction were higher in the IVS group compared to the IAL group (p , 0.05). There were no reported complications in either group at time of reduction or follow-up. Conclusions: There was no difference in ED length of stay between groups. There was a lower rate of successful reductions and lower satisfaction scores in the IAL group. RÉ SUMÉObjectif : L'objectif consistait à comparer l'injection de lidocaïne intra-articulaire (LIA) avec la sé dation intraveineuse (SIV) dans la ré duction d'une dislocation anté rieure aiguë de l'é paule au service des urgences (SU) quant à la duré e du sé jour, au taux de ré ussite de la ré duction, à la satisfaction des patients et aux complications. Mé thodes : Il s'agissait d'un essai randomisé prospectif. Les patients du groupe de la LIA ont reç u 4 mg/kg (jusqu'à 200 mg) de lidocaïne à 1 % par injection dans l'articulation de l'é paule abordé e par voie laté rale. Les patients du groupe de la SIV ont reç u des mé dicaments sé datifs choisis par le mé decin traitant. Le suivi é tait pré vu deux semaines aprè s la visite au SU afin d'é valuer les complications. Ré sultats : L'essai comptait 44 sujets (25 pour la LIA et 19 pour la SIV). Il a é té interrompu de maniè re pré coce en raison d'une combinaison de facteurs, soit des ré sultats impré vus quant à la ré ussite, des ressources limité es et le recrutement difficile des sujets. Le temps mé dian é coulé entre la premiè re é valuation par le mé decin et le congé du patient n'é tait pas diffé rent dans les deux groupes : 170 minutes pour le groupe de la LIA et 145 minutes pour la SIV (D : 225 minutes; IC à 95 % : 232, 70; p 5 0,46). Le taux de ré ussite de la ré duction par manipulation é tait significativement plus faible (p , 0,001) dans le groupe de la LIA (48 %) que dans le gro...

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Section: Discussionmentioning

confidence: 99%

Intra-articular lidocaine versus intravenous sedation for the reduction of anterior shoulder dislocations in the emergency department

Hames

McLeod

Millard

2011

CJEM

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“…Working in the US, Kosnik et al 20 compared the effectiveness of reducing dislocated shoulders using intra-articular lidocaine versus intravenous analgesia and sedation. They concluded that intravenous agents are preferred by patients, and had marginally better success rates.…”

Section: Reducing the Dislocated Joint: Analgesia And Sedation In Thementioning

confidence: 99%

Anterior Shoulder Dislocation

Cutts

Prempeh

Drew

2009

annals

160

134

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Ann R Coll Surg Engl 2009; 91: 2-7 2The glenohumeral joint of the shoulder is the most commonly dislocated joint in the human body. Acute dislocation is a surgical emergency and demands urgent relocation. Failure to reduce a dislocated shoulder successfully within the first 24 hours carries the risk that it will be impossible to achieve a stable closed reduction. 1Broadly speaking, anterior shoulder dislocation shows a bimodal age distribution (Fig. 1) Anterior dislocation of the shoulder is commonly seen in accident and emergency (A&E) and trauma clinics. In this article, we review the existing literature on the injury and the recent trends in management. MATERIALS AND METHODS We have discussed this condition with our colleagues and performed a Medline search ('anterior shoulder dislocation') of the relevant papers. We also describe key historical publications and recent developments regarding immobilisation of the joint. RESULTS Management decisions regarding this condition continue to vary between units, especially for recurrent and posterior dislocation. This paper lays some emphasis on the choice of analgesic agent when attempting shoulder reduction in the A&E setting. A summary of the data from our own department has provided a graphical representation of the classical age and sex distribution for this condition. CONCLUSIONS Shoulder dislocation is a common injury. Delays in diagnosis remain the single biggest obstacle to optimum results in this group of patients. A significant proportion will require eventual surgery and up to a third of these patients will go on to develop long-term shoulder arthritis. Even patients who have experienced a single episode of dislocation may go on to develop long-term sequelae.

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“…Patient's satisfaction with IAL has been good, although some patients with prior shoulder reductions done under sedation may prefer the same treatment 9 . Some patients may be fearful of sedation.…”

Section: Discussionmentioning

confidence: 99%

Reduction of Acute Anterior Shoulder Dislocation Using Intraarticular Lidocaine(IAL) and Stimson’s Technique

Thapa¹,

Chand²,

Kayastha³

et al. 2012

Med. J. Shree Birendra Hosp.

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Introduction: Shoulder dislocation is common injury requiring urgent reduction. For the reason that patient is not nill orally and anesthetists are not available, reduction under intra venous anaesthesia is not possible. This study was aimed to evaluate the effectiveness of intraarticular lidocaine and stimson's technique of shoulder dislocation, which could be performed without anesthetist and irrespective of nill orally status. Methods: A prospective observational study was performed from December 2009 to December 2010. Under all antiseptic precautions 20 ml of Lidocaine was injected intraarticularly and reduction was performed by Stimson's technique. Visual Analogue Score, time for reduction and failure to reduction by this technique was recorded. Results: Out of 27 dislocations 22 were successfully reduced and remaining required added scapular manipulation. The mean VAS scor was 2.3±1.26 and the mean time of reduction was 17.96±1.9 minutes. Conclusion: Stimson's method with Intraarticular Lidocaine is effective, safe, less costly and can be performed in periphery where anesthetist and monitoring facilities are not available.

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Anesthetic methods for reduction of acute shoulder dislocations: A prospective randomized study comparing intraarticular lidocaine with intravenous analgesia and sedation

Cited by 59 publications

References 8 publications

Intra-articular lidocaine versus intravenous sedation for the reduction of anterior shoulder dislocations in the emergency department

Intra-articular lidocaine versus intravenous sedation for the reduction of anterior shoulder dislocations in the emergency department

Anterior Shoulder Dislocation

Reduction of Acute Anterior Shoulder Dislocation Using Intraarticular Lidocaine(IAL) and Stimson’s Technique

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