Intra-articular Iidocaine Versus Intravenous Sedation For The Reduction Of Anterior Shoulder Dislocations:A Meta-analysis

Background: Shoulder dislocation is one of the most common emergency orthopedic diseases, accounting for40%dislocations of the whole body. The incidence of shoulder dislocation is11.2per one hundred thousand people per year. Although nearly2000years ago Hippocrates had given a detailed description of glenohumeral instability, dislocation types and closed reduction techniques, so far there is no clear consensus on the treatment of acute anterior shoulder dislocations. According to investigating studies, the majority of doctors in China considered it necessary to perform sedation before closed reduction of acute anterior shoulder dislocations,and the three most commonly used method of sedation were brachial plexus block, intravenous sedation and intra-articular lidocaine injection. Brachial plexus block is carefully used for its complicated anatomy and high risk of complications. So intravenous anesthesia has become the principal method of sedation abroad. However, intra-articular lidocaine injection has been recognized for its anvantages of simple operation, low cost and low risk of complications. Lots of trails have been performed aboard to compare between IAL and IVS for their conflicting effects on analgesia.Purpose:To analyse the superiority of intravenous sedation and intra-articular lidocaine injection, and to explore high grade evidence to confirm our conclusion. Method: We reviewed all the randomized controlled trails comparing LAL with LVS from MEDLINE, EMBASE and CENTRAL. We used random model or fixed model depending on their heterogeneity to estimated the risk ratio and95%confidence interval. Risk of bias was assessed using the recommended tool from the Cochrane Collaboration. All data was analysed using Revman5.2.Results: Of1539publications obtained from our search strategy, we reviewed11studies.4studies were excluded. And7studies with317participants were included. There was no significant difference in the success rate of closed reduction with IAL compared with IVAS (relative risk (RR)0.87;95%CI0.74to1.03). Complications were reported by all the included studies.There were significantly fewer complications associated with IAL compared with IVAS (Peto OR0.14;95%CI0.06to0.31). There was no significant difference in pain during the reduction with IAL compared with IVAS (mean difference (MD)0.32;95%CI-0.44to1.08). The mean time spent in the ED was significantly less with IAL compared with IVS (MD-104.62;95%CI-127.62to-81.62). There was significantly better successful reduction with one to two attempts associated with IAL compared with IVAS (OR0.06;95%CI0.01to0.28). There was no significant difference in successful reduction with three to four attempts associated with IAL compared with IVAS (RR1.84;95%CI0.71to4.76).Conclusion:We observed no significant difference between IAL and IVS in the success rate of reduction, pain associated with reduction.And IAL maybe associated with fewer complications and may be less expensive with shorter recovery time.