Can Intra-articular Lidocaine Supplant the Need for Procedural Sedation for Reduction of Acute Anterior Shoulder Dislocation?

Hunter, Ben; Wilbur, Lee

doi:10.1016/j.annemergmed.2011.11.008

Cited by 4 publications

(2 citation statements)

References 12 publications

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“…Our findings were in agreement with previous systematic reviews, demonstrating the benefits of intra-articular lidocaine [16,[26][27][28][29]. In a 2011 systematic review and meta-analysis by Wakai et al, comparing the clinical efficacy and safety of intra-articular lignocaine and intravenous analgesia (with or without sedation) for reduction of acute anterior shoulder dislocation, there was no significant difference between intra-articular lidocaine and IV sedation with regard to the immediate success rate of reduction, pain during reduction, post-reduction pain relief and reduction failure [27].…”

Section: Discussionsupporting

confidence: 93%

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Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis

et al. 2022

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Objective Anterior shoulder dislocations are commonly treated in the emergency department (ED). Analgesia for reduction is provided by intra-articular lidocaine (IAL) injection or intravenous sedation (IV sedation). The objective of this systematic review and meta-analysis was to compare IAL versus IV sedation for closed reduction of acute anterior shoulder dislocation in the ED. Methods Electronic searches of MEDLINE and EMBASE (1946–September 2021) were completed and reference lists were hand-searched. Randomized controlled trials (RCTs) comparing IAL and IV sedation for reduction of acute anterior shoulder dislocations among patients ≥ 15 years old in the ED were included. Outcomes of interest included a successful reduction, adverse events, ED length of stay, pain scores, procedure time, ease of reduction, patient satisfaction, and cost. Two reviewers independently screened abstracts, assessed study quality and extracted data. Data were pooled using random-effects models and reported as mean differences and risk ratios (RR) with 95% confidence intervals (CIs). Results 12 RCTs were included with a total of 630 patients (IAL = 327; IV sedation = 303). There was no difference in reduction success between IAL and IV sedation (RR 0.93; 95% CI 0.86–1.01, I 2 = 69%), significantly lower adverse events with IAL (RR 0.16; 95% CI 0.07–0.33, I 2 = 0%), shorter ED length of stay with IAL (mean difference − 1.48; 95% CI − 2.48 to − 0.47, I 2 = 93%), no difference in pain scores post-analgesia and no difference in ease of reduction. Conclusions Intra-articular lidocaine may have similar effectiveness as IV sedation in the successful reduction of anterior shoulder dislocations in the ED with fewer adverse events, shorter ED length of stay, and no difference in pain scores or ease of reduction. Intra-articular lidocaine may be an effective alternative to IV sedation for reducing anterior shoulder dislocations, particularly when IV sedation is contraindicated or not feasible. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00368-z.

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Section: Discussionsupporting

confidence: 93%

“…More recently, Jiang et al, included data from nine RCTs with a total of 438 patients and found intra-articular lidocaine may be safer than IV sedation as there were fewer complications with intra-articular lidocaine. Both techniques were similarly effective for manual closed reduction of acute anterior shoulder dislocation [ 28 ].…”

Section: Discussionmentioning

confidence: 99%