In this issue, we collaborated with the CJEM team to create a visual abstract on the December 2022 article “Intra‐articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta‐analysis1”.
Anterior shoulder dislocations often require analgesia for successful reduction in the emergency department (ED). Several randomized controlled trials have compared two types of analgesia for these reductions in the ED setting: Intra-articular lidocaine (IAL) and intravenous (IV) sedation. The authors of this paper examined the efficacy of IAL and IV sedation for successful closed reduction of anterior shoulder dislocation in the ED. Twelve RCTs were included with a total of 630 patients of which 327 had IAL and 303 underwent IV sedation.
They found that there was no difference in the reduction success between both methods with no difference in pain scores or ease of reduction. IAL was associated with fewer adverse events, reduced length of stay in the ED, and decreased cost. However, patient satisfaction was significantly greater in the IV sedation group with decreased procedural time, suggesting the benefit of this approach in resource-appropriate settings. Alternatively, in resource-limited or medically complex settings, with patients with greater risk of adverse events secondary to IV sedation, IAL may be particularly beneficial. Overall, IAL may be an effective alternative for successful reduction of anterior shoulder dislocations in the ED.
- 1.Sithamparapillai A, Grewal K, Thompson C, Walsh C, McLeod S. Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis. Can J Emerg Med. Published online October 1, 2022. doi:10.1007/s43678-022-00368-z