Abstract: Objective: The aim was to evaluate the effectiveness of intra-articular lidocaine compared to intra-venous sedation in the emergency department for reducing acute anterior shoulder dislocation. The study assessed various factors including the duration of Emergency department stay, time taken for reduction, evaluation of pain prior and post reduction, patient satisfaction and occurrence of complications.
Methods: This study was conducted as a prospective randomized trial. The intra articular lidocaine group patients were administered with 20 ml of 1% lidocaine through lateral approach, directly into the glenohumeral joint. On the other hand, patients in Intravenous sedation group received sedation medications 2mg of midazolam and 40 mic g of fentanyl intravenously. Patients were admitted and discharge 24 hours post reduction and a Follow up periods were scheduled 3 weeks, 6 weeks and 3 months to monitor for any complications and functional outcome was assessed with DASH score. This study included a total of 30 patients.
Results: 30 patients with anterior shoulder dislocation presented between January 2021 to January 2023. Patients were divided into groups were od number received intra-articular lidocaine and even numbers were administered with intra-venous sedation. Mean time taken for shoulder reduction was 8 minuets in IAS were as the mean time taken for IA sedation group was 12 minutes. Mean VAS prior to reduction was 6 and post reduction was 2.4 in IA lidocaine and for IV sedation was 6 prior and 2.8 post reduction. There were no significant variation in functional assessment in the follow up period of 3 months. There were no complications noted in IA lidocaine group, however 2 patients required monitoring post reduction in IV sedation group.
Conclusion: We hereby conclude that Intra-articular lidocaine for anterior shoulder dislocation has a good functional outcome with lesser time taken for reduction of dislocation and pain prior and post reduction as compared to traditional intravenous sedation with low incidence of post reduction monitoring of oxygen saturation, vitals and hospital stay.
