Orlinsky Michael, Shon Sammy, Chiang Charles, Chan Linda, Carter Paul
Department of Emergency Medicine, LAC+USC Medical Center, University of Southern California, Keck School of Medicine, Los Angeles, California 90033, USA.
J Emerg Med. 2002 Apr;22(3):241-5. doi: 10.1016/s0736-4679(01)00475-9.
The purpose of this study was to compare the analgesic effectiveness of intra-articular lidocaine versus intravenous meperidine and diazepam during the reduction of anterior shoulder dislocations. Patients were randomized to one of the two methods before the reduction of shoulder dislocations. Patients marked a visual analog pain scale at baseline, after anesthesia just before reduction, and at the time of discharge. Interference with the procedure caused by pain or lack of muscle relaxation, perception of adequacy of analgesia by the patient, adverse effects, and time to discharge from the Emergency Department (ED) were measured. Differences of outcomes, relative risks (RR), and 95% confidence intervals (CIs) were derived. Fifty-four patients with anterior shoulder dislocations presenting from May 21, 1998 through January 21, 1999 were included in this study; 29 were randomly assigned to receive intra-articular lidocaine (IAL) and 25 to receive intravenous meperidine/diazepam (IVMD). IAL was less effective than IVMD in relieving pre-reduction pain (p = 0.045) but equally effective in overall pain relief (p = 0.98). IAL was more effective than IVMD in shortening recovery time (p = 0.025). There was an indication favoring IVMD in terms of physician-perceived muscle relaxation and patient's perception of analgesia adequacy. In conclusion, although the IVMD method appears to have some clinically and statistically significant advantages, IAL possesses some favorable features that render it to be an analgesia alternative in shoulder dislocation reduction.
本研究的目的是比较关节内注射利多卡因与静脉注射哌替啶和地西泮在前肩脱位复位过程中的镇痛效果。在肩脱位复位前，将患者随机分为两种方法之一。患者在基线、复位前麻醉后以及出院时标记视觉模拟疼痛量表。测量疼痛或肌肉松弛不足对操作的干扰、患者对镇痛充分性的感知、不良反应以及从急诊科（ED）出院的时间。得出结果差异、相对风险（RR）和95%置信区间（CI）。本研究纳入了1998年5月21日至1999年1月21日出现前肩脱位的54例患者；29例被随机分配接受关节内注射利多卡因（IAL），25例接受静脉注射哌替啶/地西泮（IVMD）。IAL在减轻复位前疼痛方面不如IVMD有效（p = 0.045），但在总体疼痛缓解方面同样有效（p = 0.98）。IAL在缩短恢复时间方面比IVMD更有效（p = 0.025）。在医生感知的肌肉松弛和患者对镇痛充分性的感知方面，有迹象表明IVMD更具优势。总之，虽然IVMD方法似乎具有一些临床和统计学上的显著优势，但IAL具有一些有利特征，使其成为肩脱位复位中的一种镇痛选择。
