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Intra-articular lidocaine for acute anterior shoulder dislocation reduction
  1. S R Dhinakharan, Clinical Fellow,
  2. Angaj Ghosh, Senior Clinical Fellow
  1. K Mackway-Jones, Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK;
  1. kevin.mackway-jones{at}man.ac.uk

Abstract

A short cut review was carried out to establish how intra-articular lidocaine compared with intravenous analgesia and sedation during reduction of anterior shoulder dislocations. Altogether 146 papers were found using the reported search, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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Report by S R Dhinakharan,Clinical Fellow
 Checked by Angaj Ghosh, Senior Clinical Fellow

Clinical scenario

A middle aged man attends the emergency department having sustained an acute primary anterior shoulder dislocation during a fall. It is impossible to obtain peripheral venous access and you are not able to get him to breathe entonox. You are aware that shoulder dislocations can be reduced with intra-articular lidocaine (IAL). You wonder if IAL is as effective as intravenous analgesia and sedation (IVAS).

Three part question

In [patients with acute traumatic anterior shoulder dislocation] is [intra-articular lidocaine as effective as intravenous analgesia and sedation] at [facilitating reduction and easing pain associated with reduction]?

Search strategy

Medline 1966–12/01 using the Ovid interface. [exp shoulder dislocation OR shoulder dislocation.mp OR “dislocated shoulder”.mp] AND [exp anesthesia, intravenous OR exp anesthetics, intravenous OR “intravenous anaesthesia”.mp OR exp analgesia OR exp conscious sedation OR exp diazepam OR exp hypnotics and sedatives OR exp midazolam OR exp sedatives, nonbarbiturate OR sedation.mp OR exp narcotics OR narcotics.mp OR exp morphine OR morphine.mp OR exp meperidine OR meperidine.mp OR exp pethidine OR pethidine.mp OR exp lidocaine OR “lidocaine”.mp OR “lignocaine”.mp OR exp injections, intra-articular OR exp joint diseases OR intraarticular.mp OR exp anesthetics OR exp anesthetics, local OR anesthetics.mp] AND maximally sensitive RCT filter. LIMIT to human AND English.

Search outcome

Altogether 146 papers were found, of which three were relevant (table 3).

Table 3

Comment(s)

All studies were small and therefore underpowered. Larger studies are therefore needed.

CLINICAL BOTTOM LINE

Where intravenous analgesia and sedation needs to be avoided, intra-articular lidocaine should be the analgesic method of choice for reducing shoulder dislocations.

Report by S R Dhinakharan,Clinical Fellow
 Checked by Angaj Ghosh, Senior Clinical Fellow

References

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