Kashani Parvin, Asayesh Zarchi Fatemeh, Hatamabadi Hamid Reza, Afshar Abbas, Amiri Marzieh
Department of Emergency Medicine, Loghmane Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Safety Promotion & Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Turk J Emerg Med. 2016 May 9;16(2):60-64. doi: 10.1016/j.tjem.2016.04.001. eCollection 2016 Jun.
This prospective clinical trial was performed to compare the safety and efficiency of intra-articular lidocaine (IAL) versus intravenous sedative and analgesic (IVSA) in reduction of anterior shoulder dislocation.
Patients with anterior shoulder dislocation were randomly divided into 2 groups to receive IAL and IVSA. One group patients received an intravenous dose of 0.05 mg/kg midazolam and 1 μg/kg fentanyl, while the other group received 20 mL intra-articular lidocaine (1%). Patient satisfaction (via a standard 5-choice questionnaire), pain score (based on visual analog scale ranging from 0 to 10 points), comfort reduction, recovery time, and side effects were recorded and compared between the two groups before, during and after the reduction procedure.
Totally 104 patients with acute anterior shoulder dislocation and the mean age of 28.75 ± 7.24 years were included (86.5% male). There was no statistically significant difference between IAL and IVSA groups regarding age (p = 0.45) and gender (p = 0.25). A total of forty-seven (45.2%) patients, distributed in both groups, had a history of anterior shoulder dislocation. A significant difference was seen with regard to diminished pain intensity during reduction in IAL group (p < 0.001); Complications including nausea, apnea, hypoxia and headache were only observed in IVSA group, and there was no adverse effect in IAL group; increased patient satisfaction in IVSA group (p = 0.007); similar success rate at first attempt of reduction in both groups, and a shorter time to discharge in IAL group (p < 0.001).
It seems that the use of intra-articular lidocaine for reduction of anterior shoulder dislocation is effective, safe, and time saving in the emergency department and has few complications. It can be considered as the first line analgesia in managing anterior shoulder dislocation.
本前瞻性临床试验旨在比较关节内注射利多卡因（IAL）与静脉镇静镇痛（IVSA）在复位肩关节前脱位时的安全性和有效性。
将肩关节前脱位患者随机分为两组，分别接受IAL和IVSA。一组患者静脉注射0.05mg/kg咪达唑仑和1μg/kg芬太尼，另一组接受20mL关节内利多卡因（1%）。记录并比较两组患者在复位术前、术中及术后的患者满意度（通过标准的五选问卷）、疼痛评分（基于0至10分的视觉模拟量表）、舒适度降低情况、恢复时间和副作用。
共纳入104例急性肩关节前脱位患者，平均年龄28.75±7.24岁（男性占86.5%）。IAL组和IVSA组在年龄（p = 0.45）和性别（p = 0.25）方面无统计学显著差异。两组共有47例（45.2%）患者有肩关节前脱位病史。IAL组在复位过程中疼痛强度减轻方面存在显著差异（p < 0.001）；并发症包括恶心、呼吸暂停、低氧血症和头痛仅在IVSA组中观察到，IAL组无不良反应；IVSA组患者满意度提高（p = 0.007）；两组首次复位成功率相似，IAL组出院时间较短（p < 0.001）。
在急诊科，关节内注射利多卡因用于复位肩关节前脱位似乎有效、安全且节省时间，并发症少。可将其视为处理肩关节前脱位的一线镇痛方法。
