Anesthetic methods for reduction of acute shoulder dislocations: A prospective randomized study comparing intraarticular lidocaine with intravenous analgesia and sedation

A prospective, randomized, nonblinded clinical trial was undertaken to eval uate whether local intraarticular lidocaine injection (IAL) is equally effe ctive in facilitating reduction of acute anterior shoulder dislocations (AA SD) as intravenous analgesia/sedation (IVAS), The setting was an urban, Lev el 1, trauma center. Patients enrolled presented to the emergency departmen t (ED) with radiographically confirmed AASD and were randomized either to t he IVAS group or the IAL group, Ease of reduction and pain associated with reduction were measured subjectively using a 10-point scale, There were 49 patients entered into the study, 20 in the IVAS group and 29 in the IAL gro up. There was no statistically significant difference between mean +/- SD p ain scores of 3.32 +/- 2.39 in the IVAS group and 4.90 +/- 2.34 in the IAL group (P = .18), or mean +/- SD ease of reduction scores of 3.32 +/- 2.36 i n the IVAS group and 4.45 +/- 2.46 in the IAL group (P = .12). Although IVA S tended to have a higher success rate (20 of 20) than IAL (25 of 29) in th is study, Kaplan-Meier estimates far delayed time-events curves applying th e log-rank test showed that this difference was not statistically significa nt overall (P = .16). However, with reduction rate evaluated as a function of time delay in seeking treatment, patients presenting 5.5 hours after dis location were more likely to fail treatment with IAL (P = .00001). Addition ally, half of the patients in the IAL group who had experience with IVAS di d not favor IAL. Emergency physicians should be aware of IAL as an alternat ive technique that may be considered in patients when there are reasons to avoid systemic analgesia or sedation. (C) 1999 by W.B. Saunders Company.