Pain relief for reduction of acute anterior shoulder dislocations: a prospective randomized study comparing intravenous sedation with intra-articular lidocaine.

Objectives: The aim was to compare the effectiveness of intra-articular lidocaine (IAL) versus intravenous Demerol and Diazepam (IVS) in reduction of acute anterior shoulder dislocation.

Design: This is a prospective randomized study.

Setting: Emergency room setting.

Patients: Thirty-one dislocations reduced with IVS, whereas 32 patients were reduced using IAL.

Main Outcome Measurements: The visual analog pain scale was used before analgesic administration and during the closed manipulative reduction. Length of time since dislocation, frequency of dislocation, ease of reduction, patient satisfaction, adverse effects, and duration of hospitalization were recorded.

Results: The IVS group had a 100% success rate, whereas the IAL group had a 19% (six of 32) failure rate (P = 0.024). However, there was no significant difference in terms of pain relief (P = 0.23) or patient satisfaction (P = 0.085) between both groups. In addition, patients in the IAL group had a shorter duration of hospitalization and no reported complications, whereas the intravenous group had a longer hospital stay and a 29% complication rate. The cost of IAL was 32% less than the cost for IVS.

Conclusion: IAL was more cost effective than the IVS method. IAL provided adequate pain relief and fewer complications and is a viable option for analgesia during reduction of acute shoulder dislocation.