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Ultrasound-Guided Peripheral Nerve Blocks for Shoulder Dislocation in the Emergency Department: A Systemic Review
Richard J Gawel1, Renee Grill1, Nathaniel Bradley2
1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
The Journal of Emergency Medicine
|September 23, 2023
Summary
Ultrasound-guided peripheral nerve blocks (USG-PNBs) offer a safe alternative for shoulder dislocation pain relief in the emergency department. While procedural sedation may yield higher reduction success, USG-PNBs reduce adverse events, especially for patients with cardiorespiratory issues.
Area of Science:
- Emergency Medicine
- Orthopedic Surgery
- Pain Management
- Ultrasound-Guided Procedures
Background:
- Shoulder dislocations are common emergency department (ED) visits.
- Ultrasound-guided peripheral nerve blocks (USG-PNBs) are increasingly used for acute pain.
- Evidence for USG-PNBs in shoulder dislocations is limited and conflicting.
Purpose of the Study:
- To review and evaluate the utility of USG-PNBs for pain relief during closed shoulder reduction in the ED.
- To assess USG-PNBs as an alternative analgesia technique for shoulder dislocations.
Main Methods:
- Systematic literature search of PubMed, Scopus, and Cochrane databases (inception–September 2022).
- Included randomized controlled trials comparing USG-PNB with procedural sedation and analgesia.
- Collected data on demographics, block approach, outcomes, and adverse events.
Main Results:
- Patient satisfaction was similar between USG-PNB and procedural sedation (3.5 vs. 3.9 out of 5).
- Procedural sedation had higher overall (100% vs. 67%) and first-attempt (86% vs. 48%) reduction success.
- USG-PNB groups experienced shorter ED stays and significantly fewer adverse events (3.9% vs. 24.9%), particularly respiratory events (0% vs. 14.7%).
Conclusions:
- USG-PNBs are a safe and effective alternative for shoulder dislocation analgesia in the ED.
- Consider USG-PNBs for patients with cardiorespiratory comorbidities.
- Adequately trained physicians can perform USG-PNBs effectively.
