title: Intraarticular lidocaine versus intravenous analgesic for reduction of acute anterior shoulder dislocations. A prospective randomized study.
abstract: We performed a prospective, randomized study to evaluate the use of injected lidocaine as an anesthetic for closed reduction of acute anterior shoulder dislocations. Thirty consecutive patients who presented at the emergency department with acute anterior shoulder dislocations were randomly placed in one of two groups. One group received an intraarticular injection of 20 ml of 1% lidocaine and the other group, intravenous injections of morphine sulfate and midazolam. The groups were compared regarding time of reduction maneuver, difficulty of reduction, subjective pain, complications, and total time spent in the emergency department. The lidocaine provided adequate anesthesia and secondary relief of muscle spasm in 15 of 15 (100%) patients. When compared with the intravenous sedation group, the lidocaine group showed no statistically significant difference in time for reduction maneuver, difficulty of reduction, or subjective pain. The lidocaine group had no complications and had a statistically significant shorter emergency department visit when compared with the intravenous sedation group (mean, 78 minutes versus 186 minutes; P = 0.004). Lidocaine provides excellent anesthesia for patients with uncomplicated anterior shoulder dislocations and can be very beneficial when sedation is contraindicated. Lidocaine injections also proved to be cost effective in our institution, reducing total costs by as much as 62%.
authors.affiliation: Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson 39216.
authors.forename: D E
authors.initials: DE
authors.lastname: Matthews
authors.forename: T
authors.initials: T
authors.lastname: Roberts
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000465:Algorithms; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007275:Injections, Intravenous; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008349:Manipulation, Orthopedic / Q000191:economics / Q000379:methods*; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D011446:Prospective Studies; D012783:Shoulder Dislocation / Q000628:therapy*; D013997:Time Factors
chemical_list: D009020:Morphine; D008012:Lidocaine; D008874:Midazolam