Intra-articular lidocaine for acute anterior shoulder dislocation reduction
Date First Published:
November 10, 2000
Last Updated:
February 19, 2003
Report by:
SR Dhinakharan, Clinical Fellow (Manchester Royal Infirmary)
Search checked by:
Angaj Ghosh, Manchester Royal Infirmary
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]?
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).
Search Strategy:
Medline 1966-12/01 using the Ovid interface.
Search Details:
[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.
Outcome:
146 papers were found, of which 3 were relevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Reduction of traumatic secondary shoulder dislocations with lidocaine. Suder PA, Mikkelsen JB, Hougaard K, et al. 1995, Denmark | 52 patients with secondary traumatic shoulder dislocation patients IAL (26) vs IVAS (26) |
PRCT | Pain | Insignificant difference (p=0.08) | Small size |
| Subjective evaluation | Insignificant difference (p=0.19) | ||||
| Mean time | 16.1 + 3.5 vs 4.7 + 2.9 (p=0.001) | ||||
| Result of reduction | No significant difference (p=0.19) | ||||
| Intraarticular lidocaine versus intravenous analgesic for reduction of acute anterior shoulder dislocations. A prospective randomized study. Matthews DE, Roberts T. 1995, USA | 30 consecutive patients presenting to the emergency department with acute anterior shoulder dislocation IAL (15) vs IVAS (15) |
PRCT | Time to reduction, difficulty of reduction, subjective pain | No statistically significant difference | Small size Varied reduction techniques Statistical methods not described |
| Time in emergency department | Significant reduction in the IAL group | ||||
| Complications | No complications | ||||
| Anesthetic methods for reduction of acute shoulder dislocations: a prospective randomized study comparing intraarticular lidocaine with intravenous analgesia and sedation. Kosnik J, Shamsa F, Raphael E et al. 1999, USA | 49 patients presenting to the emergency department with acute anterior shoulder dislocation IAL (29) vs IVAS (20) |
PRCT | Success rate | 20/20 for IVAS vs 24/29 for IAL (p=0.07) | Small sample size Varied physician experience Varied reduction techniques |
| Ease of reduction (SD) | 3.32 (2.36) for IVAS vs 4.45 (2.46) for IAL (p=0.12) | ||||
| Pain score (SD) | 3.95 (2.39) for IVAS vs 4.90 (2.34) for IAL (p=0.18) |
Author Commentary:
All studies were small and therefore underpowered. Larger studies are therefore needed.
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.
References:
- Suder PA, Mikkelsen JB, Hougaard K, et al.. Reduction of traumatic secondary shoulder dislocations with lidocaine.
- Matthews DE, Roberts T.. Intraarticular lidocaine versus intravenous analgesic for reduction of acute anterior shoulder dislocations. A prospective randomized study.
- Kosnik J, Shamsa F, Raphael E et al.. Anesthetic methods for reduction of acute shoulder dislocations: a prospective randomized study comparing intraarticular lidocaine with intravenous analgesia and sedation.