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%.