BET 1: Can acute shoulder dislocations be reduced using intra-articular local anaesthetic infiltration as an alternative to intravenous analgesia with or without sedation?

Penn, Michael; Williams, Owen

doi:10.1136/emermed-2020-210736.2

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…Our findings were in agreement with previous systematic reviews, demonstrating the benefits of intra-articular lidocaine [ 16 , 26 – 29 ]. In a 2011 systematic review and meta-analysis by Wakai et al, comparing the clinical efficacy and safety of intra-articular lignocaine and intravenous analgesia (with or without sedation) for reduction of acute anterior shoulder dislocation, there was no significant difference between intra-articular lidocaine and IV sedation with regard to the immediate success rate of reduction, pain during reduction, post-reduction pain relief and reduction failure [ 27 ].…”

Section: Discussionsupporting

confidence: 93%

“…IV sedation may be the preferred option in a well-resourced setting when treating a patient who has previously had a difficult reduction, has significant apprehension to being alert during the procedure, has local anesthetic allergy or toxicity risk, or when the provider has discomfort with joint injection technique. Although intra-articular lidocaine may be associated with less patient satisfaction, intra-articular lidocaine may be beneficial to consider in several settings, including in low-resourced settings (e.g., single coverage EDs or remote communities) where access to IV sedation drugs or equipment may be limited or not feasible [ 29 ]. Additionally, in EDs where healthcare dollars are limited (e.g., low-income communities/countries, patients who must pay for treatment out of pocket), intra-articular lidocaine may offer similar clinical outcomes to IV sedation at a lower cost [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis

et al. 2022

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Objective Anterior shoulder dislocations are commonly treated in the emergency department (ED). Analgesia for reduction is provided by intra-articular lidocaine (IAL) injection or intravenous sedation (IV sedation). The objective of this systematic review and meta-analysis was to compare IAL versus IV sedation for closed reduction of acute anterior shoulder dislocation in the ED. Methods Electronic searches of MEDLINE and EMBASE (1946–September 2021) were completed and reference lists were hand-searched. Randomized controlled trials (RCTs) comparing IAL and IV sedation for reduction of acute anterior shoulder dislocations among patients ≥ 15 years old in the ED were included. Outcomes of interest included a successful reduction, adverse events, ED length of stay, pain scores, procedure time, ease of reduction, patient satisfaction, and cost. Two reviewers independently screened abstracts, assessed study quality and extracted data. Data were pooled using random-effects models and reported as mean differences and risk ratios (RR) with 95% confidence intervals (CIs). Results 12 RCTs were included with a total of 630 patients (IAL = 327; IV sedation = 303). There was no difference in reduction success between IAL and IV sedation (RR 0.93; 95% CI 0.86–1.01, I 2 = 69%), significantly lower adverse events with IAL (RR 0.16; 95% CI 0.07–0.33, I 2 = 0%), shorter ED length of stay with IAL (mean difference − 1.48; 95% CI − 2.48 to − 0.47, I 2 = 93%), no difference in pain scores post-analgesia and no difference in ease of reduction. Conclusions Intra-articular lidocaine may have similar effectiveness as IV sedation in the successful reduction of anterior shoulder dislocations in the ED with fewer adverse events, shorter ED length of stay, and no difference in pain scores or ease of reduction. Intra-articular lidocaine may be an effective alternative to IV sedation for reducing anterior shoulder dislocations, particularly when IV sedation is contraindicated or not feasible. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00368-z.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis

et al. 2022

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“…More commonly used anesthetic techniques in the ED for shoulder dislocation reductions are IAL and IV sedation, which we will refer to as procedural sedation (PS). Prior data have suggested the use of IAL results in shorter hospital length of stay (LOS)[ 8 9 11 12 ] and may be safer[ 11 12 ] than PS for shoulder dislocation reductions. However, those data come from studies that used medications that have fallen out of favor for PS, namely opioids and benzodiazepines.…”

Section: Introductionmentioning

confidence: 99%

Intra-Articular Lidocaine versus Procedural Sedation for Shoulder Dislocation Reduction

Zitek

Koneri

Georges

et al. 2022

Journal of Emergencies, Trauma, and Shock

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Introduction: Two common ways of providing anesthesia for shoulder dislocation reductions in the emergency department (ED) are intra-articular lidocaine (IAL) injections and procedural sedation (PS). We sought to compare PS with propofol or etomidate to IAL for shoulder dislocation reductions in the ED. Methods: This was an open-label, randomized controlled trial of patients aged 18–70 years with anterior shoulder dislocations who presented to a single ED. We randomized patients to either PS or IAL for their shoulder dislocation reduction. The primary outcome measure was ED length of stay (LOS). Secondarily, we assessed patient satisfaction and the number of attempts required for successful reduction. Results: We identified 60 patients who met the criteria for enrollment, and were able to enroll 43. We randomized 23 patients to IAL and 20 to PS. In the IAL group, the mean ED LOS was 133 min as compared to 124 min for the PS group (difference 9 min [95% confidence interval (CI)-22–41], P = 0.54). Patients in the IAL group required an average of 1.9 reduction attempts as compared to 1.2 in the PS group (difference of 0.7 [95% CI 0.2–1.2]). The mean patient satisfaction scores were similar at 9.7 and 9.8 for the IAL and PS groups, respectively. Conclusions: This study lacked a sufficient sample size to detect small differences but found no statistically significant difference in mean ED LOS or patient satisfaction for patients who received IAL as compared to PS. Patients in the PS group required fewer attempts for successful reduction.

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Peripheral Nerve Blocks for Headache: A Precise Approach to Pain Management in the Emergency Department

Friedman

2022

Annals of Emergency Medicine

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BET 1: Can acute shoulder dislocations be reduced using intra-articular local anaesthetic infiltration as an alternative to intravenous analgesia with or without sedation?

Cited by 4 publications

References 15 publications

Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis

Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis

Intra-Articular Lidocaine versus Procedural Sedation for Shoulder Dislocation Reduction

Peripheral Nerve Blocks for Headache: A Precise Approach to Pain Management in the Emergency Department

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