Use of intra-articular lidocaine as analgesia in anterior shoulder dislocation: a review and meta-analysis of the literature.

INTRODUCTION: The shoulder joint is the most commonly injured major joint in patients who present to the hospital emergency department today. In the community the incidence of shoulder joint injuries is 11.2 cases per 100,000 person-years. Traditionally, procedural sedation and analgesia (PSA) has been used to facilitate the reduction of anterior shoulder dislocations. However, there are risks of complication, such as respiratory depression, particularly in certain populations. As such, the use of intra-articular lidocaine (IAL) has been suggested as an alternative method of analgesia.

METHODS: We searched EMBASE (Ovid) and MEDLINE (PubMed) databases using the keywords "shoulder, dislocation, and/or reduction" from the respective start dates of the databases until October 2008.

RESULTS: Based on the current literature, it appears that the IAL method provides, at a minimum, the same level of pain control and reduction success as the procedural sedation method, while markedly reducing the time spent by the patient in the emergency department and the cost of treatment. The likelihood of complications is arguably less with the use of IAL.

CONCLUSION: Although more research is this area is merited, physicians may consider IAL as an alternative to PSA in the management of anterior shoulder dislocations.