Tezel Onur, Kaldirim Umit, Bilgic Serkan, Deniz Suleyman, Eyi Yusuf Emrah, Ozyurek Selahattin, Durusu Murat, Tezel Nihal
Department of Emergency Medicine, Gulhane Military Medical Academy, 06018 Ankara, Turkey.
Department of Emergency Medicine, Gulhane Military Medical Academy, 06018 Ankara, Turkey.
Am J Emerg Med. 2014 Jun;32(6):549-52. doi: 10.1016/j.ajem.2014.02.014. Epub 2014 Feb 17.
Dislocation of the shoulder joint is one of the most common dislocations. The reduction procedure is a painful procedure. In this study, 2 different treatment groups were compared for pain control during shoulder dislocation reduction. It was aimed to evaluate the differences between the groups in reduction, success, length of hospital stay, complications, side effects, patient-physician satisfaction, and ease of application.
The study was planned to be prospective and randomized. As procedural sedation analgesia (SA), titration of ketamine 1 to 2 mg/kg was administered intravenously to group 1. Suprascapular nerve block (SNB) was applied under ultrasound guidance (USG) to group 2. Conformity to normal distribution of variables was examined with the Kolmogorov-Smirnov test. The χ2 test and Fisher test were used to evaluate differences between the groups in categorical variables and the Mann-Whitney U test, and a value of P<.05 was accepted as statistically significant.
The study comprised a total of 41 patients; 20 in the group 1 and 21 in the group 2. No statistically significant difference was determined between the groups in terms of age (P=.916), sex (P=.972), reduction success (P=.540), and patient-physician satisfaction (P=.198). The time spent in the emergency department (ED) by patients in the SA group was signficantly longer compared with the SNB group. No side effects were observed in the SNB group.
Suprascapular nerve block, which can be easily applied under USG in the ED, can be evaluated as a good alternative to SA in the reduction of shoulder dislocations.
肩关节脱位是最常见的脱位类型之一。复位过程是一个痛苦的过程。在本研究中，比较了2个不同治疗组在肩关节脱位复位过程中的疼痛控制情况。旨在评估两组在复位、成功率、住院时间、并发症、副作用、患者-医生满意度以及应用便利性方面的差异。
本研究计划为前瞻性随机研究。作为程序性镇静镇痛（SA），第1组静脉注射1至2mg/kg的氯胺酮进行滴定。第2组在超声引导（USG）下进行肩胛上神经阻滞（SNB）。使用Kolmogorov-Smirnov检验检查变量是否符合正态分布。χ2检验和Fisher检验用于评估分类变量组间差异以及Mann-Whitney U检验，P<0.05的值被认为具有统计学意义。
该研究共纳入41例患者；第1组20例，第2组21例。两组在年龄（P=0.916）、性别（P=0.972）、复位成功率（P=0.540）和患者-医生满意度（P=0.198）方面未发现统计学显著差异。SA组患者在急诊科（ED）花费的时间明显长于SNB组。SNB组未观察到副作用。
肩胛上神经阻滞在急诊科可在超声引导下轻松实施，可被视为肩关节脱位复位中SA的良好替代方法。
