Reduction of traumatic secondary shoulder dislocations with lidocaine

The aim of the present study was to evaluate the value of local anaesthesia versus the commonly used intravenous pethidine/diazepam in the reduction of acute secondary shoulder dislocations. Patients with a traumatic secondary dislocation of the shoulder were randomized to either locally injected lidocaine or intravenously injected pethidine/diazepam. The local method was performed with 20 ml of 1% lidocaine. The patients were observed for any complication during and after the procedure, and the methods used were evaluated with a visual analogue scale (VAS). From November 1991 to September 1993, 62 patients were admitted to our departments of whom 52 were included in the study. Average age was 47 years (range 18-89 years) with 24 men and 28 women. Twenty-six patients were randomized to pethidine/diazepam; 22 had a successful reduction, and 4 were failures. Twenty-six patients received lidocaine, of whom 18 were successful and 8 not. Three patients treated with the intravenous method suffered respiratory depression, and one required an antidote. No systemic or local side-effects, no neurovascular damage and no early or late superficial or deep infection were recorded in the lidocaine group. There was no statistical difference between the average VAS value in the two groups. Lidocaine used to reduce acute secondary dislocations of the shoulder is a simple and safe method. It is as effective as the standard intravenous method and is well accepted by patients.