The Journal of Bone and Joint Surgery (American) 84:2135-2139 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Comparison of Intra-Articular Lidocaine and Intravenous Sedation for Reduction of Shoulder Dislocations
A Randomized, Prospective Study
Suzanne L. Miller, MD,
Edmond Cleeman, MD,
Joshua Auerbach, MD and
Evan L. Flatow, MD
Investigation performed at the Department of Orthopaedics, The Mount Sinai Hospital, New York, NY
Suzanne L. Miller, MD
Edmond Cleeman, MD
Joshua Auerbach, MD
Evan L. Flatow, MD
Department of Orthopaedics, The Mount Sinai Hospital, 5 East 98th Street, Box 1188, New York, NY 10029. E-mail address for E.L. Flatow: evan.flatow{at}msnyuhealth.org
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).
Background: Acute anterior glenohumeral dislocations have been commonly treated with closed reduction and the use of intravenous sedation. Recently, the use of intra-articular lidocaine has been advocated as an alternative to sedation, since intravenous access and patient monitoring are not required. The purpose of this study was to evaluate the value of local anesthesia compared with that of the commonly used intravenous sedation during the performance of a standardized reduction technique.
Methods: In a prospective, randomized study, skeletally mature patients with an isolated glenohumeral joint dislocation and no associated fracture were randomized to receive either intravenous sedation or intra-articular lidocaine to facilitate reduction of the dislocation. Reduction was performed with the modified Stimson method. The two groups were compared with regard to the rate of successful reduction, pain as rated on a visual analog scale, time required for the reduction, time from the reduction until discharge from the emergency department, and cost.
Results: Thirty patients were enrolled in the study. Five (two in the lidocaine group and three in the sedation group) required scapular manipulation in addition to the Stimson technique to reduce the dislocation. The lidocaine group spent significantly less time in the emergency department (average time, seventy-five minutes compared with 185 minutes in the sedation group, p < 0.01). There was no significant difference between the two groups with regard to pain (p = 0.37), success of the Stimson technique (p = 1.00), or time required to reduce the shoulder (p = 0.42). The cost of the intravenous sedation was $97.64 per patient compared with $0.52 for use of the intra-articular lidocaine.
Conclusions: Use of intra-articular lidocaine to facilitate reduction with the Stimson technique is a safe and effective method for treating acute shoulder dislocations in an emergency room setting. Intra-articular lidocaine requires less money, time, and nursing resources than does intravenous sedation to facilitate reduction with the Stimson technique.
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