Ultrasound-guided interscalene block versus intravenous analgesia and sedation for reduction of first anterior shoulder dislocation

• Published in: The American journal of emergency medicine Vol. 56; pp. 232 - 235
• Main Authors: Yao, Liwei, Dong, Wenwei, Wu, Zeting, Zhao, Qingzhen, Mao, Haijiao
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2022; Elsevier Limited
• Subjects: Analgesia; Analgesia - methods; Anesthesia; Anesthetics, Local - therapeutic use; Arthroscopy - adverse effects; Arthroscopy - methods; Brachial Plexus Block - methods; Consciousness; Dislocation; Emergency medical care; Fentanyl; General anesthesia; Headaches; Hospitals; Humans; Hypoxia; Interscalene block; Intravenous administration; Nausea; Pain; Pain - complications; Pain perception; Pain, Postoperative - drug therapy; Pain, Postoperative - prevention & control; Patient satisfaction; Patients; Prospective Studies; Reduction; Shoulder; Shoulder - surgery; Shoulder dislocation; Shoulder Dislocation - complications; Shoulder Dislocation - surgery; Surgery; Surgical outcomes; Ultrasonic imaging; Ultrasonography, Interventional; Ultrasound; Vomiting; United States > US; Shoulder dislocation; General anesthesia; Reduction; Interscalene block
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2022.03.047

This study aims to compare the efficacy of ultrasound-guided interscalene block (US-ISB) with that of intravenous analgesia and sedation (IVAS) in reducing first shoulder dislocation. A prospective study was performed in 66 patients with first anterior shoulder dislocation in emergency department. The patients were divided into a US-ISB (n = 32) group and an IVAS (IVAS n = 34) group. The procedure time (anesthesia, reduction, and hospital times), pain score (before, during, and after reduction), reduction attempts, complications, and patient satisfaction were recorded and compared between the two groups. The anesthesia time (P < 0.01) and reduction time (P < 0.01) were shorter and the hospital time (P < 0.01) was longer in the IVAS group than in the US-ISB group. No significant differences in preoperative (P = 0.18) and postoperative (P = 0.27) pain scores were found between the two groups, but the intraoperative score of the US-ISB group was significantly higher than that of the IVAS group. More reduction attempts (P < 0.01) were recorded in the US-ISB group than that in the IVAS group. Complications (P < 0.01) such as nausea, vomiting, headache, and hypoxia occurred more frequently in the IVAS group than in the US-ISB group. No significant difference in patient satisfaction was observed between two groups (P = 0.96). Compared with IVAS group, US-ISB group reduces the time to discharge and achieves lesser complication. The pain score and reduction attempt are lower in the IVAS group than in the US-ISB group.