Intra-articular lidocaine for closed reduction of ankle fracture-dislocations
Date First Published:
April 7, 2010
Last Updated:
June 3, 2011
Report by:
Ala Mohammed, Speciality Registrar (Sunderland Royal Hospital, Sunderland, UK)
Search checked by:
Malcolm Jones , Sunderland Royal Hospital, Sunderland, UK
Three-Part Question:
In [adult patients with ankle fracture-dislocation] is [intra-articular lidocaine as effective as intravenous analgesia and sedation] at [facilitating reduction with adequate analgesia]?
Clinical Scenario:
An elderly man attends the emergency department with a clinical fracture dislocation of the ankle after a fall. He has got significant co morbidities and a history of recent myocardial infection. You have read that ankle fracture-dislocations can be reduced with intra-articular lidocaine (IAL). You wonder if IAL is as effective as intravenous analgesia and sedation (IVAS) in facilitating reduction and providing adequate analgesia.
Search Strategy:
Medline 1966–04/10 searched through NLH Search 2.0 using the following terms: [exp ankle injuries/ or exp dislocations/] AND [exp injections, intra-articular/].
Outcome:
The search revealed 75 papers, with one randomized controlled trail directly answering the 3 part question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Intra-articular block compared with conscious sedation for closed reduction of ankle fracture-dislocations. A prospective randomized trial White BJ, Walsh M, Egol KA, Tejwani NC. 2008, USA | 42 skeletally mature patients with ankle fracture dislocation. IAL(21) v IVAS(21) |
PRCT | Reduction of pain | Pre-intervention pain scores were 9.2 for the IAL group and 9.3 for the IVAS group. Post-intervention scores were 3.6 vs 4.1 (p¼0.71) | Unblinded study with small numbers. Various sedatives used |
| Ease of reduction (SD) | No significant difference between the two groups |
Author Commentary:
This study suggests that intra-articular lidocaine can be as effective as intravenous analgesia and sedation to facilitate the reduction of ankle fracture-dislocations. This would be a useful alternative technique for use in patients who are high-risk for anaesthetic due to comorbidities, body habitus or a full stomach etc, where urgent reduction is required.
Bottom Line:
Intra-articular lidocaine can be considered as an alternative method to facilitate reduction of fracture-dislocation of an ankle in patients who are high-risk for conscious sedation.
Level of Evidence:
Level 1: Recent well-done systematic review was considered or a study of high quality is available
References:
- White BJ, Walsh M, Egol KA, Tejwani NC.. Intra-articular block compared with conscious sedation for closed reduction of ankle fracture-dislocations. A prospective randomized trial