Which medications are used in the treatment of shoulder dislocation?

Updated: Nov 29, 2018
  • Author: Sharon R Wilson, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

Opiate analgesia should be given as needed for pain in patients with shoulder dislocation. Intravenous or intramuscular medications, intra-articular injections, and regional anesthetic techniques have been reported as successful aides for reduction of shoulder dislocations.

Procedural sedation and analgesia (PSA) is commonly used to achieve adequate pain control and muscle relaxation for reduction. A randomized, controlled trial of 30 patients compared intra-articular lidocaine with PSA (morphine and midazolam). [37] All patients who received intra-articular injections obtained adequate analgesia and muscle relaxation, were free of complications, and had significantly shorter emergency department stays (78 min vs 186 min; P=0.004). [37] A Cochrane Database of Systematic Review of 113 patients with acute anterior shoulder dislocation who underwent intra-articular lidocaine injection and 98 patients who underwent intravenous analgesia with sedation found that intra-articular lidocaine injection may be associated with fewer side effects and a shorter stay in the ED and may be less expensive than intravenous medication. [38]

Etomidate, fentanyl/midazolam, ketamine, or propofol is commonly used for PSA. Some ED physicians prefer etomidate because of its rapid onset (< 30 sec), short duration (about 5 min), and excellent muscle relaxation. Other physicians consider propofol superior in terms of side effects and duration. Propofol's high lipid solubility results in a rapid onset (30-60 sec) and a short plasma half-life (1.3-4.1 min). The result is a rapid decline of propofol concentrations, rapid awakening, and shorter recovery times.

An ED-based study evaluated the combination of propofol and remifentanil for sedation to reduce anterior shoulder dislocations. [39] Eleven patients were given propofol 0.5 mg/kg and remifentanil 0.5 mcg/kg IV over 90 seconds. Further doses of propofol 0.25 mg/kg and remifentanil 0.25 mcg/kg were administered if needed. All patients had adequate sedation and analgesia within 3 minutes. Mean time to achieve reduction after dosage was 1.6 minutes, and mean time to being clinically alert was 3 minutes. However, postreduction time in the ED ranged from 30-312 minutes. Rapid recovery was a marked feature of this study. All patients became alert quickly and were ambulatory without assistance in less than 30 minutes.


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