Intraarticular Lidocaine Versus Intravenous Analgesic for Reduction of Acute Anterior Shoulder Dislocations

Abstract

We performed a prospective, randomized study to evaluate the use of injected lidocaine as an anesthetic for closed reduction of acute anterior shoulder dislocations. Thirty consecutive patients who presented at the emergency department with acute anterior shoulder dislocations were randomly placed in one of two groups. One group received an intraarticular injection of 20 ml of 1% lidocaine and the other group, intravenous injections of morphine sulfate and midazolam. The groups were compared regarding time of reduction maneuver, difficulty of reduction, subjective pain, complications, and total time spent in the emergency department. The lidocaine provided adequate anesthesia and secondary relief of muscle spasm in 15 of 15 (100%) patients. When compared with the intravenous sedation group, the lidocaine group showed no statistically significant difference in time for reduction maneuver, difficulty of reduction, or subjective pain. The lidocaine group had no complications and had a statistically significant shorter emergency department visit when compared with the intravenous sedation group (mean, 78 minutes versus 186 minutes; P = 0.004). Lidocaine provides excellent anesthesia for patients with uncomplicated anterior shoulder dislocations and can be very beneficial when sedation is contraindicated. Lidocaine injections also proved to be cost effective in our institution, reducing total costs by as much as 62%.

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

“…9 However, despite this, mean ED length of stay for the IVS group in our study (172 minutes) was similar to previously published times (186 minutes, 3 185 minutes 8 ). However, the ED length of stay for the IAL group (197 minutes) was greater than those previously published (78 minutes, 3 75 minutes 8 ). It remains unclear why this discrepancy occurred.…”

“…Two studies found significantly decreased ED length of stays when IAL was used compared to IVS. 3,8 A recent systematic review of published studies comparing the two methods found that there was no difference in the success rate between IAL and IVS and the immediate complication rate was significantly higher in the IVS groups. 9 The authors concluded that IAL should be considered as a first-line therapy for shoulder reductions in the ED.…”

Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial

“…[10][11][12]27 The time required to achieve the reduction was also shorter in the intra-articular injection group, thus supporting the hypothesis that improved analgesia secondarily provides greater muscle relaxation, which facilitates shoulder reduction. 10 One patient was withdrawn from the control group, whereas in the group treated with intra-articular lidocaine injection, all the individuals remained until the end of the study. One previous study 10 found similar results with regard to reduction failures; however, others have reported that failures also occurred using the intra-articular injection method.…”

“…10 One patient was withdrawn from the control group, whereas in the group treated with intra-articular lidocaine injection, all the individuals remained until the end of the study. One previous study 10 found similar results with regard to reduction failures; however, others have reported that failures also occurred using the intra-articular injection method. The latter may be due to the number of patients evaluated.…”

Estudo transversal sobre os diferentes métodos de tratamento das luxações traumáticas glenoumerais: a cross-sectional study

“…Algumas medicações são contraindicadas em casos de gravidez, traumas que envolvam a monitorização do sistema nervoso central e órgãos intra-abdominais (25) . Até recentemente não havia alternativa para os analgésicos e sedativos por via oral e parenteral.…”