Written by Clay Smith
Intra-articular lidocaine (IAL) compared to IV sedation for shoulder dislocation reduction had similar reduction of pain, fewer complications, lower cost, and decreased ED length of stay. However, some patients prefer sedation over IAL, and first time success may be higher with sedation.
Why does this matter?
I use intra-articular lidocaine for most shoulder reductions. A dislocated shoulder makes a huge space to hit to enter the joint space. For adults, feel the lateral acromion, move inferior 2cm, insert a 22ga needle about 2-3cm deep, aspirate, and inject 10mL of 1% lidocaine. It’s really easy. In my experience, it seems to help the pain, but what does the evidence say?
Let’s blow this joint
This was a short cut review that found 11 relevant studies, 9 were RCTs. This is not a systematic review or meta-analysis. Evidence was conflicting as to whether IAL reduced pain. Overall, reduction of pain was similar with IAL vs sedation. Satisfaction with treatment favored sedation; some groups of patient preferred to have reduced consciousness. First time success of reduction was higher in the sedation group. ED length of stay was less as was cost in the IAL group. Side effects, like vomiting or respiratory depression were higher in the sedation group.
BET 1: Can acute shoulder dislocations be reduced using intra-articular local anaesthetic infiltration as an alternative to intravenous analgesia with or without sedation? Emerg Med J. 2020 Nov;37(11):725-728. doi: 10.1136/emermed-2020-210736.2.
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