Intra-Articular Lidocaine versus Procedural Sedation for Shoulder Dislocation Reduction: A Randomized Trial

Area of Science:

• Emergency Medicine
• Anesthesiology
• Orthopedics

Background:

• Shoulder dislocation reduction in the ED commonly uses intra-articular lidocaine (IAL) or procedural sedation (PS).
• Comparing the efficacy and patient experience of these two anesthesia methods is crucial for optimizing emergency care.

Purpose of the Study:

• To compare procedural sedation (PS) with propofol or etomidate versus intra-articular lidocaine (IAL) for shoulder dislocation reductions in the emergency department (ED).
• To evaluate differences in ED length of stay (LOS), patient satisfaction, and reduction attempt success rates.

Main Methods:

• An open-label, randomized controlled trial was conducted with 43 patients aged 18-70 presenting with anterior shoulder dislocations.
• Patients were randomized to receive either IAL injection or PS for reduction.
• Primary outcome was ED LOS; secondary outcomes included patient satisfaction and number of reduction attempts.

Main Results:

• Mean ED LOS was 133 minutes for IAL versus 124 minutes for PS (P=0.54).
• Patients receiving PS required fewer reduction attempts (1.2) compared to IAL (1.9).
• Patient satisfaction scores were similar between groups (9.7 for IAL, 9.8 for PS).

Conclusions:

• No statistically significant difference in ED LOS or patient satisfaction was found between IAL and PS.
• Procedural sedation was associated with a lower number of reduction attempts for shoulder dislocation.
• The study was limited by sample size, suggesting further research is needed.