Comparison of intra-articular lidocaine and intravenous sedation for reduction of shoulder dislocations: a randomized, prospective study.

Abstract

BACKGROUND:

Acute anterior glenohumeral dislocations have been commonly treated with closed reduction and the use of intravenous sedation. Recently, the use of intra-articular lidocaine has been advocated as an alternative to sedation, since intravenous access and patient monitoring are not required. The purpose of this study was to evaluate the value of local anesthesia compared with that of the commonly used intravenous sedation during the performance of a standardized reduction technique.

METHODS:

In a prospective, randomized study, skeletally mature patients with an isolated glenohumeral joint dislocation and no associated fracture were randomized to receive either intravenous sedation or intra-articular lidocaine to facilitate reduction of the dislocation. Reduction was performed with the modified Stimson method. The two groups were compared with regard to the rate of successful reduction, pain as rated on a visual analog scale, time required for the reduction, time from the reduction until discharge from the emergency department, and cost.

RESULTS:

Thirty patients were enrolled in the study. Five (two in the lidocaine group and three in the sedation group) required scapular manipulation in addition to the Stimson technique to reduce the dislocation. The lidocaine group spent significantly less time in the emergency department (average time, seventy-five minutes compared with 185 minutes in the sedation group, p < 0.01). There was no significant difference between the two groups with regard to pain (p = 0.37), success of the Stimson technique (p = 1.00), or time required to reduce the shoulder (p = 0.42). The cost of the intravenous sedation was $97.64 per patient compared with $0.52 for use of the intra-articular lidocaine.

CONCLUSIONS:

Use of intra-articular lidocaine to facilitate reduction with the Stimson technique is a safe and effective method for treating acute shoulder dislocations in an emergency room setting. Intra-articular lidocaine requires less money, time, and nursing resources than does intravenous sedation to facilitate reduction with the Stimson technique.

• Authors: Suzanne L Miller, Edmond Cleeman, Joshua Auerbach, Evan L Flatow
• Journal: The Journal of bone and joint surgery. American volume (J Bone Joint Surg Am) Vol. 84 Issue 12 Pg. 2135-9 (Dec 2002) ISSN: 0021-9355 [Print] United States
• PMID: 12473699 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Anesthetics, Local
• Lidocaine

Topics

• Adolescent
• Adult
• Aged
• Anesthetics, Local (administration & dosage)
• Conscious Sedation (methods)
• Humans
• Injections, Intra-Articular
• Injections, Intralesional
• Injections, Intravenous
• Lidocaine (administration & dosage)
• Middle Aged
• Prospective Studies
• Shoulder Dislocation (therapy)