Intra-articular lidocaine versus intravenous meperidine/diazepam in anterior shoulder dislocation: a randomised clinical trial

Moharari, Reza Shariat; Khademhosseini, Peyman; Espandar, Ramin; Soleymani, H Asl; Talebian, Mohammad Taghi; Khashayar, Patricia; Nejati, Amir

doi:10.1136/emj.2007.051060

Cited by 17 publications

(53 citation statements)

References 8 publications

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“…Previously published studies have introduced several methods for reduction of shoulder dislocation paying more attention to anterior form due to its higher incidence. Some of them have compared IAL and IVSA, sedative effect of inhalational and intra-venous methods and also assessed different maneuvers for reduction of acute anterior shoulder dislocation 2, 4, 6, 14, 20, 21, 22, 23. Among them, more attention was paid to IAL use compared to IVSA.…”

Section: Discussionmentioning

confidence: 99%

“…Despite opposing results in this context, favorable impacts of lidocaine should not be ignored, which include adequate muscle relaxation, less pain and cost, prompt patient discharge, adequacy for patients in whom intravenous access is not easily obtainable, and not needing oxygen saturation monitoring and electrocardiography during or after reduction 1, 4, 10, 14. Few prospective controlled trials have compared IAL and IVSA from the standpoint of effectiveness, safety, time taken, ED overcrowding, and especially pain intensity in acute anterior shoulder dislocation patients in Iran 15 . Therefore, this prospective clinical trial was performed to compare the safety and efficiency of intra-articular lidocaine (IAL) versus intravenous sedative and analgesic (IVSA) in reduction of anterior shoulder dislocation.…”

Section: Introductionmentioning

confidence: 99%

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Intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation

Kashani

Zarchi

Hatamabadi

et al. 2016

Turkish Journal of Emergency Medicine

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ObjectiveThis prospective clinical trial was performed to compare the safety and efficiency of intra-articular lidocaine (IAL) versus intravenous sedative and analgesic (IVSA) in reduction of anterior shoulder dislocation.Materials and methodsPatients with anterior shoulder dislocation were randomly divided into 2 groups to receive IAL and IVSA. One group patients received an intravenous dose of 0.05 mg/kg midazolam and 1 μg/kg fentanyl, while the other group received 20 mL intra-articular lidocaine (1%). Patient satisfaction (via a standard 5-choice questionnaire), pain score (based on visual analog scale ranging from 0 to 10 points), comfort reduction, recovery time, and side effects were recorded and compared between the two groups before, during and after the reduction procedure.ResultsTotally 104 patients with acute anterior shoulder dislocation and the mean age of 28.75 ± 7.24 years were included (86.5% male). There was no statistically significant difference between IAL and IVSA groups regarding age (p = 0.45) and gender (p = 0.25). A total of forty-seven (45.2%) patients, distributed in both groups, had a history of anterior shoulder dislocation. A significant difference was seen with regard to diminished pain intensity during reduction in IAL group (p < 0.001); Complications including nausea, apnea, hypoxia and headache were only observed in IVSA group, and there was no adverse effect in IAL group; increased patient satisfaction in IVSA group (p = 0.007); similar success rate at first attempt of reduction in both groups, and a shorter time to discharge in IAL group (p < 0.001).ConclusionIt seems that the use of intra-articular lidocaine for reduction of anterior shoulder dislocation is effective, safe, and time saving in the emergency department and has few complications. It can be considered as the first line analgesia in managing anterior shoulder dislocation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation

Kashani

Zarchi

Hatamabadi

et al. 2016

Turkish Journal of Emergency Medicine

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“…Out of the 6 studies, 5 used 20 mL of 1% lidocaine, while 1 study used 4 mg/kg of 1% lidocaine. 4 Four studies described the technique for IAL: 2 studies used the posterior approach, 4,12 1 the anterior approach, 8 and another injected lateral to the acromion through the lateral sulcus. 6 In the IVS groups, several agents were used in varying dosages, including morphine, diazepam, meperidine, pethidine, midazolam, and fentanyl.…”

Section: Resultsmentioning

confidence: 99%

“…None of these studies in the IVS groups used anesthetics now commonly used for procedural sedation. 4,8,10,12 The most common agents used today include propofol, ketamine, etomidate, and versed, as well as narcotic analgesics such as morphine and fentanyl. 1,2 …”

Section: Resultsmentioning

confidence: 99%

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Intra-articular Lidocaine Injection for Shoulder Reductions

Waterbrook

Paul

2011

Sports Health

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Context:The shoulder is the most commonly dislocated joint, and shoulder dislocations are very common in sports. Many of these dislocations present to the office or training room for evaluation. Usual practice is an attempt at manual reduction without analgesia and then transfer to the emergency department if unsuccessful. The clinical efficacy of intra-articular lidocaine for reduction of anterior shoulder dislocations in the outpatient setting was examined.Evidence Acquisition:An OVID MEDLINE search (1966-present) was performed using the keywords shoulder, reduction, and analgesia as well as shoulder, intra-articular, and lidocaine. Search limits included articles in the English language. Bibliographic references from these articles were also examined to identify pertinent literature.Results:Six randomized controlled clinical trials were identified that directly addressed this clinical technique. Although the reduction techniques used in these studies were not controlled, there was no statistically significant difference in success rates between groups. The complication rate, length of stay, and costs were significantly less in the intra-articular lidocaine group when compared with the intravenous sedation group.Conclusions:According to current evidence, the use of intra-articular lidocaine injection for reduction of anterior shoulder dislocations is not harmful and is likely advantageous in the outpatient clinical setting.

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Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults

Wakai

O’Sullivan

McCabe

2011

Cochrane Database of Systematic Reviews

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Intra-articular lidocaine versus intravenous meperidine/diazepam in anterior shoulder dislocation: a randomised clinical trial

Abstract: Intra-articular injection of lidocaine before closed reduction of anterior shoulder dislocation produces the same pain relief as intravenous meperidine and diazepam.

Cited by 17 publications

References 8 publications

Intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation

Intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation

Intra-articular Lidocaine Injection for Shoulder Reductions

Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults

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