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

Parvin Kashani; Fatemeh Asayesh Zarchi; Hamid Reza Hatamabadi; Abbas Afshar; Marzieh Amiri

doi:10.1016/j.tjem.2016.04.001

Parvin Kashani¹, Fatemeh Asayesh Zarchi¹, Hamid Reza Hatamabadi², Abbas Afshar³, Marzieh Amiri⁴

^aDepartment of Emergency Medicine, Loghmane Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
^bSafety Promotion & Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
^cDepartment of Management, Mofateh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
^dDepartment of Emergency Medicine, Shahid Beheshti Hospital, Guilan University of Medical Sciences, Anzali, Iran

Keywords: Shoulder dislocation; Lidocaine; Intra-articular; Pain management; Emergency department

Abstract

Objective: This 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 methods: Patients 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.

Results: Totally 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).

Conclusion: It 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.