Raeyat Doost E et al., Am J Emerg Med 2017 Apr 14;
Nerve block was faster but sedation was somewhat more effective in this small randomized trial.
|For reduction of anterior shoulder dislocations, options include procedural sedation, intraarticular lidocaine injection, nerve block, and manipulation without sedation. Investigators in Iran randomized 60 adults undergoing anterior shoulder dislocation to ultrasound-guided interscalene brachial plexus block or sedation with fentanyl (2 µg/kg) plus propofol (1 mg/kg). Primary outcomes were patient-reported pain and emergency department (ED) length of stay (time from commencement of the nerve block or sedation procedure to discharge); secondary outcomes included patient satisfaction.
The nerve block group had a significantly shorter ED stay than the sedation group (mean, 80 vs. 109 minutes) but more pain during the procedure (mean score, 3.4 vs. 0.4 points on a 5-point numeric rating scale) and lower satisfaction (mean score, 3.0 vs. 3.6 on a 4-point scale). No significant adverse events were recorded.