reDuction oF acute anterior sHoulDer Dislocations: comParing intraarticular lignocaine witH intravenous anestHesia

Abstract

Anterior shoulder dislocation is the most common dislocation in the body. Various methods of
anesthesia are available for reduction. The objective of this study was to compare the application
of intra-articular anesthesia with intravenous anesthesia for reduction of acute anterior shoulder
dislocation. This study was conducted at Kathmandu Medical College Teaching Hospital (KMCTH)
and Kathmandu Hospital and comprised of patients coming with anterior dislocation of shoulder
from July 2001 to June 2005. Forty-five patients aged 17-55 years with no associated fractures of
adjoining bones were included in the study. In twenty-three patients, reduction was done using intra-articular anesthesia and in 22 patients intravenous anesthesia was given. In five patients (three in
intra-articular group and two in intravenous group) the reduction technique had to be changed to
the Hippocratic method. In these three patients intravenous anesthesia had to be given after intra-articular anesthesia failed to relieve pain and spasm. In the intravenous group two patients had to
be admitted overnight while in the intra-articular group none had to be admitted to the hospital.
However, in the intra-articular group the average time taken from injection to reduction was sig-nificantly longer (<.001). The use of intra-articular lignocaine for reduction of shoulder dislocation
is safe and effective especially when patients present early. In patients presenting late (more than 5
hours) intravenous anesthesia should be primarily considered as the method for shoulder reduction.
Key Words: Shoulder dislocation, intra-articular anesthesia, intravenous anesthesia, reduction.