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Anterior shoulder dislocations are commonly seen during an ED shift.
During a busy shift, the choice of analgesia may be a strong consideration.
Analgesia for reduction can be provided by intra-articular lidocaine injection or intravenous sedation among other options.
How do these 2 analgesic options compare?
Additional Information
A 2022 systematic review of 12 RCTs (630 patients).
327 in Lidocaine group
303 in IV sedation group
Patients aged 15 years or older
Outcomes of interest included a successful reduction, adverse events, ED length of stay, pain scores, procedure time, ease of reduction, patient satisfaction, and cost.
Conclusions:
There was no difference in reduction success between groups
As one would expect, significantly lower adverse events with lidocaine
As one would expect, shorter ED length of stay with lidocaine
No difference in pain scores post-analgesia during reduction
No difference in ease of reduction
Patient satisfaction was greater with sedation.
**This likely reflects being awake and processing the experience vs. being asleep and waking up to the finished product.
Conclusions
Intra-articular lidocaine may have similar effectiveness as IV sedation in the successful reduction of anterior shoulder dislocations in the ED with fewer adverse events, shorter ED length of stay, and no difference in pain scores or ease of reduction but may be associated with lower patient satisfaction.
Consider intra-articular lidocaine as an effective alternative to IV sedation for reducing anterior shoulder dislocations.
References
Sithamparapillai A, Grewal K, Thompson C, Walsh C, McLeod S. Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis. CJEM. 2022 Dec;24(8):809-819.