Evidence in orthopaedics: comparison of intra-articular lidocaine vs. intravenous analgesia and sedation for reduction of acute shoulder dislocation

Abstract

Acute shoulder dislocation is the most common joint dislocation managed in emergency department. It has been commonly treated with closed reduction and the use of intravenous analgesia and sedation (IVAS). Recently, intra-articular lidocaine (IAL) has been advocated as an alternative to sedation, since intravenous access and patient monitoring are not required. A careful literature analysis was performed to establish which anesthetic method is best indicated to reach a reduction that is easily performed, effective, relatively painless and safe, and to allow for expeditious discharge of the patient. To find the best evidence on the topic, we searched in the Cochrane Library, Health Technology Assessment (HTA) database, TRIP, Medline, CINAHL, and EMBASE. In the four prospective randomized clinical trials found, no statistically significant difference was detected between IAL and IVAS for reduction of acute anterior shoulder dislocations with regard to pain score, difficulty of reduction, and success rate. Although we cannot definitively state which is the best anesthetic method, we conclude that intra-articular injection of lidocaine is an excellent alternative for those patients for whom IVAS is not indicated.