Intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation

Abstract

ObjectiveThis prospective clinical trial was performed to compare the safety and efficiency of intra-articular lidocaine (IAL) versus intravenous sedative and analgesic (IVSA) in reduction of anterior shoulder dislocation.Materials and methodsPatients with anterior shoulder dislocation were randomly divided into 2 groups to receive IAL and IVSA. One group patients received an intravenous dose of 0.05 mg/kg midazolam and 1 μg/kg fentanyl, while the other group received 20 mL intra-articular lidocaine (1%). Patient satisfaction (via a standard 5-choice questionnaire), pain score (based on visual analog scale ranging from 0 to 10 points), comfort reduction, recovery time, and side effects were recorded and compared between the two groups before, during and after the reduction procedure.ResultsTotally 104 patients with acute anterior shoulder dislocation and the mean age of 28.75 ± 7.24 years were included (86.5% male). There was no statistically significant difference between IAL and IVSA groups regarding age (p = 0.45) and gender (p = 0.25). A total of forty-seven (45.2%) patients, distributed in both groups, had a history of anterior shoulder dislocation. A significant difference was seen with regard to diminished pain intensity during reduction in IAL group (p < 0.001); Complications including nausea, apnea, hypoxia and headache were only observed in IVSA group, and there was no adverse effect in IAL group; increased patient satisfaction in IVSA group (p = 0.007); similar success rate at first attempt of reduction in both groups, and a shorter time to discharge in IAL group (p < 0.001).ConclusionIt seems that the use of intra-articular lidocaine for reduction of anterior shoulder dislocation is effective, safe, and time saving in the emergency department and has few complications. It can be considered as the first line analgesia in managing anterior shoulder dislocation.

Diagnosis &amp; Treatment of an Anterior Shoulder Dislocation with Bedside Ultrasound

“…[1][2][3] Reducing a dislocated shoulder generally requires intravenous (IV) conscious sedation or an intra-articular anesthetic injection. 4 Traditionally, IV conscious sedation has been the method of choice for shoulder reduction, but intra-articular joint injection is becoming more accepted as a viable alternative. 1,3,5 A systematic review of randomized controlled trials (RCTs) discovered no significant statistical difference in successful anterior shoulder dislocation reduction between IV sedation and intra-articular injections.…”

“…5 Potential complications of conscious sedation include respiratory depression, hypoxia, apnea, nausea, aspiration, hypotension, and increased sedation recovery time. [4][5][6][7] Moreover, conscious sedation typically requires the availability and presence of a nurse to assist, further increasing the patient's ED length of stay. In comparison, intra-articular injections can be done quickly at the bedside and require less recovery time while still providing adequate analgesia.…”

Chondrotoxic effects of intra-articular anesthetics in shoulders

“…Kashani and colleagues 1 do make note of possible chondrolytic effects of local anesthetic injections in the study limitations paragraph but state that it is uncommon.…”

“…With great interest we read the article of Kashani and colleagues “Intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation”. 1 This article that has been recently published in your journal describes the interesting results of a randomized controlled trial that compared intra-articular lidocaine with intravenous sedation for the treatment of shoulder dislocations.…”

“…Although we agree with the benefits of intra-articular sedation over local sedation, we feel that possible disadvantages of the use of intra-articular lidocaine have not been properly addressed. Kashani and colleagues 1 do make note of possible chondrolytic effects of local anesthetic injections in the study limitations paragraph but state that it is uncommon.…”