[Reduction of traumatic primary anterior shoulder dislocation under local analgesia]

The aim of the present study was to evaluate the value of local versus intravenous anaesthesia in the reduction of acute shoulder dislocations. Patients with a primary traumatic dislocation of the shoulder were randomized to either local lidocaine or intravenous anaesthesia with pethidine/diazepam. The local method was performed with 20 ml of 1% lidocaine. The intravenous method was performed with pethidine/diazepam injected intravenously. The patients were observed for any complication during and after the procedure and the used methods were evaluated using a Visual Analogue Scale (VAS). In the period from November 1991 to September 1993 81 patients were admitted to our departments and 68 patients were included. Average age was 48 years (range 15-79) with 29 men and 39 women. Thirty-five patients were randomized to intravenous anaesthesia, 33 had a successful reduction and two failed. Thirty-three patients received local anaesthesia, 32 succeeded and one failed. Ten patients treated with the intravenous method had respiratory depression and six required antidote. No systemic or local side effects and no neuro-vascular injuries were recorded with the use of lidocaine. We did not observe any superficial or deep infection in the lidocaine group. There was no statistical difference between the average VAS value in the two groups. Local anaesthesia used to reduce acute primary anterior dislocation of the shoulder is a simple, safe and well-accepted method with significantly fewer respiratory complications.