Department of Emergency Medicine, University of California Los Angeles, Los Angeles, California.
Department of Emergency Medicine, and Department of Anesthesia, Center for Pain Medicine, University of California San Diego, La Jolla, California.
J Emerg Med. 2023 Mar;64(3):405-408. doi: 10.1016/j.jemermed.2023.01.009. Epub 2023 Mar 15.
Anterior glenohumeral dislocation is a common injury seen in the emergency department (ED) that sometimes requires procedural sedation for manual reduction. When compared with procedural sedation for dislocation reductions, peripheral nerve blocks provide similar patient satisfaction scores but have shorter ED length of stays. In this case report, we describe the first addition of an ultrasound-guided axillary nerve block to a suprascapular nerve block for reduction of an anterior shoulder dislocation in the ED.
A 34-year-old man presented to the ED with an acute left shoulder dislocation. The patient was a fit rock climber with developed muscular build and tone. An attempt to reduce the shoulder with peripheral analgesia was unsuccessful. A combined suprascapular and axillary nerve block was performed with 0.5% bupivacaine, allowing appropriate relaxation of the patient's musculature while providing excellent pain control. The shoulder was then successfully reduced without procedural sedation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Procedural sedation for reduction of anterior shoulder dislocations is time consuming, resource intensive, and can be risky in some populations. The addition of an axillary nerve block to a suprascapular nerve block allows for more complete muscle relaxation to successfully reduce a shoulder dislocation without procedural sedation.
前肩盂脱位是急诊科常见的损伤，有时需要进行程序性镇静以进行手动复位。与脱位复位的程序性镇静相比，外周神经阻滞提供了相似的患者满意度评分，但急诊科的住院时间更短。在本病例报告中，我们描述了首例在超声引导下腋神经阻滞联合肩胛上神经阻滞用于急诊科急性前肩盂脱位复位的情况。
一名 34 岁男性因急性左肩脱位到急诊科就诊。该患者是一名体格健壮的攀岩运动员，肌肉发达，线条分明。尝试使用外周镇痛来复位肩部失败。随后进行了肩胛上神经和腋神经联合阻滞，使用 0.5%布比卡因，使患者的肌肉得到适当放松，同时提供了极佳的疼痛控制。然后无需程序性镇静即可成功复位肩部。
为什么急诊医生应该了解这一点？：对于前肩盂脱位的复位，程序性镇静既费时又费力，在某些人群中还存在风险。肩胛上神经阻滞联合腋神经阻滞可使肌肉更完全松弛，无需程序性镇静即可成功复位肩脱位。
