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Intra-articular lidocaine versus intravenous sedation for the reduction of anterior shoulder dislocations in the emergency department

Published online by Cambridge University Press:  11 May 2015

Heather Hames ,
Shelley McLeod  and
Wanda Millard
Heather Hames*
Affiliation:
Division of Emergency Medicine, The University of Western Ontario Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON
Shelley McLeod
Affiliation:
Division of Emergency Medicine, The University of Western Ontario
Wanda Millard
Affiliation:
Division of Emergency Medicine, The University of Western Ontario Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON
*
800 Commissioners Road, E1-100, London, ON N6A 5W9; heather.hames@londonhospitals.com

Abstract

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Objective:

The objective was to compare intra-articular lidocaine (IAL) versus intravenous sedation (IVS) for the reduction of acute, anterior shoulder dislocations in the emergency department (ED) in terms of ED length of stay, rate of successful reductions, patient satisfaction, and complications.

Methods:

This was a prospective, randomized trial. Patients in the IAL group received 4 mg/kg (up to 200 mg) of 1% lidocaine injected into the glenohumeral joint using a lateral approach. Patients in the IVS group received medications for sedation as per the discretion of the treating physician. Follow-up was arranged within 2 weeks of the ED visit to assess for complications.

Results:

Forty-four patients (25 IAL, 19 IVS) were included. This trial was stopped early owing to a combination of unexpected findings in success, resource limitations, and difficulty in patient enrolment. Median time from first physician assessment to patient discharge was not different between the IAL (170 minutes) group and the IVS (145 minutes) group (Δ –25 minutes; 95% CI –32, 70; p = 0.46). There was a significantly lower rate (p < 0.001) of successful closed reduction in the IAL group (48%) compared to the IVS group (100%). Patient satisfaction and physician ease of reduction were higher in the IVS group compared to the IAL group (p < 0.05). There were no reported complications in either group at time of reduction or follow-up.

Conclusions:

There was no difference in ED length of stay between groups. There was a lower rate of successful reductions and lower satisfaction scores in the IAL group.

Keywords

emergency departmentintra-articular lidocaineprocedural sedationshoulder reduction
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 6 , November 2011 , pp. 378 - 383
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

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