Intra-articular lidocaine as good as IV sedation for acute anterior shoulder dislocation closed reduction

The most frequent kind of joint dislocation seen in the emergency department (ED) is an anterior shoulder dislocation, which accounts for 95% of all shoulder dislocations. Muscle relaxation and patient cooperation are crucial for reduction to be successful. As a result, analgesia is often needed. For the reduction of an anterior shoulder dislocation, intra-articular lidocaine and intravenous sedation (IV sedation) are two analgesic options. Intra-articular lidocaine may be a useful substitute for intravenous sedation for minimizing anterior shoulder dislocations, especially in situations when intravenous sedation is contraindicated or impractical. This was shown by a recent metaanalysis.

Reference lists were hand-searched in addition to electronic searches of MEDLINE and EMBASE (1946–September 2021). Included were randomized controlled studies (RCTs) that compared IAL and IV sedation for the prevention of acute anterior shoulder dislocations in ED patients under the age of 15. The following outcomes were of particular interest: a successful reduction, adverse events, duration of stay in the emergency department, pain ratings, procedure time, ease of reduction, patient satisfaction, and cost. Abstracts were evaluated, research quality was determined, and data were retrieved separately by two reviewers. Following the pooling of the data using random-effects models, the mean differences and risk ratios (RR) with 95% confidence intervals (CIs) were reported. A total of 630 participants from 12 RCTs (303 under IV sedation and 327 with IAL) were included. There was no difference in reduction success between IAL and IV sedation (RR 0.93; 95% CI 0.86-1.01, I2 = 69%). There was also no difference in pain scores following analgesia or ease of reduction.