Nerve Block vs. Sedation for Reduction of Anterior Shoulder Dislocation

September 26, 2017 by Dr. Clemens Leave a Comment

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.

Comment

Procedural sedation is the most common and accepted method for control of symptoms during reduction of anterior shoulder dislocations. In this study, the use of fentanyl at a dose of 2 µg/kg might have deepened the sedation and prolonged the length of stay. With propofol, lower analgesic doses or no analgesic at all might be faster. Nerve block is a great option for patients facing high risk from procedural sedation, such as the very elderly and those with relevant comorbidities, and if it can be performed soon after injury, scapular manipulation without any sedation may be possible as well.

Leave a Reply Cancel reply

You must be logged in to post a comment.

Call (660) 596-2224

What people thought about us

“As Director of Surgical Services Departments there has been considerable changes have occurred in my department and Anesthesia Experts has always risen to meet our demands of our facility. They have been very pro-active in meeting the increase volumes allowing us to keep our surgeons and patients very satisfied with our services.”

AR BSN 346 beds AL

“Before AE took over the anesthesia department was described by the surgeons as the worst in the history of our hospital. The prior management company was having a cancelled surgery per day. I am happy to report there has not been one since they have taken over the department. Additionally we have seen a 905 reduction if requested preop
lab tests. The anesthesia department is now the very best hospital department in our entire facility.”

DS CEO 272 beds MS

“Anesthesia Experts has provided consistent anesthesia providers who display a high degree of integrity, responsibility and professionalism. They have become a more valuable part of our facility and community.”

LR CEO 150 beds TX

“Even though they are physically located 1000 miles away Anesthesia Experts just does not provide great anesthesia coverage they personally engage surgeons to increase their business. Last year my surgical volume rose by 24% and we are currently 50% ahead of last year and all of that growth is organic.”

JE FACHE CEO AL 92 bed hospital

“Anesthesia Experts is more responsive than anyone I have dealt with. They are available by phone whenever needed and will be on site for any need or request and has been on site to address issues before we can make the request.”

SW CEO 25 beds NM

“While problems are extremely rare when they do occur Anesthesia Experts quickly and professionally implements a solution. Our surgical volume has grown over 100 cases per month and now our GI docs want to perform all of their endoscopies in our hospital instead of their GI lab that they own!”

SP CEO 346 beds AL

“Our anesthesia department was a thorn in my side that kept me awake at night. Anesthesia Experts swept in and brought order to our mess and our department was quickly redirected.”

JAM CNO AL 89 bed hospital