Wakai Abel, O'Sullivan Ronan, McCabe Aileen
Emergency Care Research Unit [ECRU], Midland Regional Hospital, Arden Road, Tullamore, Co. Offaly, Ireland.
Cochrane Database Syst Rev. 2011 Apr 13;2011(4):CD004919. doi: 10.1002/14651858.CD004919.pub2.
There is conflicting evidence regarding the use of intra-articular lignocaine injection for the closed manual reduction of acute anterior shoulder dislocations. A systematic review may help cohere the conflicting evidence.
To compare the clinical efficacy and safety of intra-articular lignocaine and intravenous analgesia (with or without sedation) for reduction of acute anterior shoulder dislocation.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), and EMBASE (1980 to March 2010). We searched Current Controlled Trials metaRegister of Clinical Trials (compiled by Current Science) (March 2010). We imposed no language restriction.
Randomized controlled trials comparing intra-articular lignocaine (IAL) with intravenous analgesia with or without sedation (IVAS) in adults aged 18 years and over for reduction of acute anterior shoulder dislocation.
Two authors independently assessed trial quality and extracted data. Where possible, data were pooled and relative risks (RR) and mean differences (MD), each with 95% confidence intervals (CI), were computed using the Cochrane Review Manager statistical package (RevMan).
Of 1041 publications obtained from the search strategy, we examined nine studies. Four studies were excluded, and five studies with 211 participants were eligible for inclusion. There was no difference in the immediate success rate of IAL when compared with IVAS in the closed manual reduction of acute anterior shoulder dislocation (RR 0.95; 95% CI 0.83 to 1.10). There were significantly fewer adverse effects associated with IAL compared with IVAS (RR 0.16; 95% CI 0.06 to 0.43). The mean time spent in the emergency department was significantly less with IAL compared with IVAS (MD 109.46 minutes; 95% CI 84.60 to 134.32). One trial reported significantly less time for reduction with IVAS (105 seconds; 95% CI 84.0 to 126.1) compared with IAL (284.6 seconds; 95% CI 185.3 to 383.9). One trial reported no joint infection associated with intra-articular lignocaine injection and no mortality associated with either IAL or IVAS.
AUTHORS' CONCLUSIONS: We observed no significant difference between IAL and IVAS with regard to the immediate success rate of reduction, pain during reduction, post-reduction pain relief and reduction failure. Compared to IVAS, IAL may be less expensive and may be associated with fewer adverse effects and a shorter recovery time.
关于关节内注射利多卡因用于急性前肩关节脱位闭合手法复位的证据存在冲突。系统评价可能有助于整合这些相互矛盾的证据。
比较关节内注射利多卡因与静脉镇痛（有或无镇静）用于急性前肩关节脱位复位的临床疗效和安全性。
我们检索了Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2010年第1期）、MEDLINE（1950年至2010年3月）和EMBASE（1980年至2010年3月）。我们检索了当前对照试验临床试验元注册库（由Current Science编制）（2010年3月）。我们没有设置语言限制。
比较关节内注射利多卡因（IAL）与有或无镇静的静脉镇痛（IVAS）用于18岁及以上成年人急性前肩关节脱位复位的随机对照试验。
两位作者独立评估试验质量并提取数据。在可能的情况下，对数据进行合并，并使用Cochrane系统评价管理软件（RevMan）计算相对风险（RR）和平均差（MD），以及各自的95%置信区间（CI）。
从检索策略中获得的1041篇出版物中，我们审查了9项研究。排除了4项研究，5项研究共211名参与者符合纳入标准。在急性前肩关节脱位闭合手法复位中，IAL与IVAS相比，即时成功率没有差异（RR 0.95；95%CI 0.83至1.10）。与IVAS相比，IAL相关的不良反应明显更少（RR 0.16；95%CI 0.06至0.43）。与IVAS相比，IAL在急诊科的平均停留时间明显更短（MD 109.46分钟；95%CI 84.60至134.32）。一项试验报告，与IAL（284.6秒；95%CI 185.3至383.9）相比，IVAS复位时间明显更短（105秒；95%CI 84.0至126.1）。一项试验报告关节内注射利多卡因未发生关节感染，IAL或IVAS均未导致死亡。
我们观察到IAL和IVAS在复位即时成功率、复位时疼痛、复位后疼痛缓解及复位失败方面无显著差异。与IVAS相比，IAL可能成本更低，不良反应更少，恢复时间更短。
