Intra-articular lidocaine reduces pain in anterior shoulder dislocations: Study

The successful reduction of anterior shoulder dislocations in the emergency department (ED) may be achieved using intra-articular lidocaine in a manner comparable to that of intravenous sedation, says an article published in Canadian Journal of Emergency Medicine.

In the emergency room, anterior shoulder dislocations are often treated. Intra-articular lidocaine (IAL) injection or intravenous sedation are two methods of providing analgesia for reduction (IV sedation). This study was done by Arjun Sithamparapillai and his colleagues to compare closed reduction of acute anterior shoulder dislocation under IAL and IV sedation in the emergency department.

Reference lists were manually searched, and electronic searches of MEDLINE and EMBASE (1946–September 2021) were performed. IAL and IV sedation were compared in randomized controlled trials (RCTs) to reduce acute anterior shoulder dislocations in ED patients under the age of 15. A successful reduction, adverse events, duration of stay in the emergency department, pain ratings, ease of reduction, procedure time, patient satisfaction, and cost were among the outcomes of interest. Two reviewers independently selected abstracts, judged the caliber of the studies, and collected data. Mean differences and risk ratios (RR) with 95% confidence intervals were produced as a result of pooling the data using random-effects models.

The key findings of this study were:

1. A total of 630 individuals from 12 RCTs were included (303 under IV sedation and 327 with IAL).

2. Between IAL and IV sedation, there was no difference in reduction success, no difference in adverse events, no difference in the length of stay in the ED, no difference in pain scores following analgesia, and no difference in the ease of reduction.

In conclusion, with fewer side effects, a shorter duration of stay in the ED, and no difference in pain scores or ease of reduction, intra-articular lidocaine may be as effective as IV sedation in successfully reducing anterior shoulder dislocations in the emergency department. When IV sedation is neither recommended or practical, intra-articular lidocaine may be a good substitute for it in order to reduce anterior shoulder dislocations.

Reference:

Sithamparapillai, A., Grewal, K., Thompson, C., Walsh, C., & McLeod, S. (2022). Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis. In Canadian Journal of Emergency Medicine. Springer Science and Business Media LLC. https://doi.org/10.1007/s43678-022-00368-z