title: Reduction of anterior shoulder dislocation in emergency department; is entonox(®) effective?
abstract: BACKGROUND
  An appropriate procedural sedation and analgesia (PSA) is crucial to reduce a dislocated shoulder successfully in emergency department. This study compares sedative effect of inhalational Entonox(®) (En) to intra-venous (IV) Midazolam plus Fentanyl (F+M).
  
  
  METHODS
  120 patients with recurrent anterior shoulder dislocation were randomly assigned into two groups. 60 patients (group F+M) received 0.1 mg/kg IV Midazolam plus 3µg/kg IV Fentanyl and 60 patients (group En) received Entonox(®) with self administration face mask on an on-demand basis. Traction/counter-traction method was used to reduce the dislocated shoulder joint in both groups.
  
  
  RESULTS
  48 out of 60 (80%) patients in group F+M and 6 out of 60 (10%) patients in group En had successful reduction (p < 0.0001). The mean pain score reduction was 6.3 ± 1.2 for group F+M and 3 ± 0.9 for group En (p < 0.0001). There was a statistically significant difference in mean patient satisfaction (assessed with Likert score) between two groups (4.45 ± 0.6 for group F+M and 2.3 ± 1 for group En; p < 0.0001). Duration of entire procedure (since the beginning of PSA up to the end of successful or unsuccessful reduction) was shorter in Group F+M, but successful reductions occurred earlier in group En. No major side effect such as airway compromise, retracted respiratory depression, or circulatory failure was occurred in any group.
  
  
  CONCLUSIONS
  Entonox(®) may not be an appropriate agent to help reducing a dislocated shoulder.
authors.affiliation: Department of Emergency Medicine, Rasul-Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Babak
authors.initials: B
authors.lastname: Mahshidfar
authors.forename: Ali
authors.initials: A
authors.lastname: Asgari-Darian
authors.forename: Hamed-Basir
authors.initials: HB
authors.lastname: Ghafouri
authors.forename: Gurkan
authors.initials: G
authors.lastname: Ersoy
authors.forename: Mohammad-Reza
authors.initials: MR
authors.lastname: Yasinzadeh
keywords: Entonox®; Fentanyl; Midazolam; Procedural Sedation and Analgesia; Shoulder Dislocation; Shoulder Reduction