title: Intra-articular lidocaine versus intravenous analgesia and sedation for manual closed reduction of acute anterior shoulder dislocation: an updated meta-analysis.
abstract: OBJECTIVE
  To compare intra-articular lidocaine (IAL) with intravenous analgesia and sedation (IVAS) for manual closed reduction of acute anterior shoulder dislocation.
  
  
  METHODS
  Meta-analysis.
  
  
  METHODS
  Metropolitan medical university.
  
  
  METHODS
  A literature search was conducted of PubMed, Ovid and Cochrane Library, to identify randomized controlled trials (RCTs) published from January 1, 1990 to September 1, 2012, that compared IAL with IVAS for manual closed reduction of acute anterior shoulder dislocation. Effective data were pooled using fixed-effects or random-effects models with mean differences (MDs) and risk ratios (RRs) for continuous and dichotomous variables, respectively.
  
  
  RESULTS
  Nine RCTs comprising 438 patients were analyzed. Statistical analyses showed that IAL was superior to IVAS with respect to lower complication risk (P < 0.00001) and shorter mean hospital length of stay (P = 0.03). No significant differences were noted in success of joint reduction (P = 0.16), patient satisfaction (P = 0.12), or postreduction pain relief (P = 0.76). However, IAL required more time than IVAS from injection to reduction (P < 0.00001). Subgroup analyses showed that IVAS was associated with higher risks of respiratory depression (P < 0.0001), vomiting (P = 0.04), and thrombophlebitis (P = 0.008), but no statistical differences were identified in nausea (P = 0.06), hypotension (P = 0.10), drowsiness (P = 0.45), or headache (P = 0.29).
  
  
  CONCLUSIONS
  Intra-articular lidocaine injection may be safer than IVAS because there are fewer risks of postoperative complications with IAL. Both techniques are similarly effective for manual closed reduction of acute anterior shoulder dislocation.
authors: Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, P.R. China.
authors: Nan
authors: N
authors: Jiang
authors: Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, P.R. China.
authors: Yan-jun
authors: YJ
authors: Hu
authors: Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, P.R. China.
authors: Kai-rui
authors: KR
authors: Zhang
authors: Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, P.R. China.
authors: Sheng
authors: S
authors: Zhang
authors: Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, P.R. China. Electronic address: nanfanghot@126.com.
authors: Yu
authors: Y
authors: Bin
mesh_terms: D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007270:Injections, Intra-Articular; D007275:Injections, Intravenous; D007902:Length of Stay; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D012783:Shoulder Dislocation / Q000628:therapy*; D013997:Time Factors
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D008012:Lidocaine
keywords: Anterior shoulder dislocation; Intra-articular lidocaine; Intravenous analgesia; Lidocaine; Meta-analysis; Randomized controlled trials