title: Intra-articular lidocaine versus intravenous sedation for the reduction of anterior shoulder dislocations in the emergency department.
abstract: OBJECTIVE
  The objective was to compare intra-articular lidocaine (IAL) versus intravenous sedation (IVS) for the reduction of acute, anterior shoulder dislocations in the emergency department (ED) in terms of ED length of stay, rate of successful reductions, patient satisfaction, and complications.
  
  
  METHODS
  This was a prospective, randomized trial. Patients in the IAL group received 4 mg/kg (up to 200 mg) of 1% lidocaine injected into the glenohumeral joint using a lateral approach. Patients in the IVS group received medications for sedation as per the discretion of the treating physician. Follow-up was arranged within 2 weeks of the ED visit to assess for complications.
  
  
  RESULTS
  Forty-four patients (25 IAL, 19 IVS) were included. This trial was stopped early owing to a combination of unexpected findings in success, resource limitations, and difficulty in patient enrolment. Median time from first physician assessment to patient discharge was not different between the IAL (170 minutes) group and the IVS (145 minutes) group (Δ -25 minutes; 95% CI -32, 70; p  =  0.46). There was a significantly lower rate (p < 0.001) of successful closed reduction in the IAL group (48%) compared to the IVS group (100%). Patient satisfaction and physician ease of reduction were higher in the IVS group compared to the IAL group (p < 0.05). There were no reported complications in either group at time of reduction or follow-up.
  
  
  CONCLUSIONS
  There was no difference in ED length of stay between groups. There was a lower rate of successful reductions and lower satisfaction scores in the IAL group.
authors.forename: Heather
authors.initials: H
authors.lastname: Hames
authors.forename: Shelley
authors.initials: S
authors.lastname: McLeod
authors.forename: Wanda
authors.initials: W
authors.lastname: Millard
mesh_terms: D000328:Adult; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004630:Emergencies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007270:Injections, Intra-Articular; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D012783:Shoulder Dislocation / Q000628:therapy*; D012785:Shoulder Joint
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D008012:Lidocaine; D015742:Propofol