Sedative-free Reduction of Acute Anterior Shoulder Dislocation Saves Postreduction Service Time in the Emergency Room
Keywords:
Acute anterior shoulder dislocation, emergency room, reduction, sedative-free, sedation, postsedative recovery, service timeAbstract
Background: Emergency room service is a workload and congestion. Acute anterior shoulder dislocationis commonly encountered in emergency room and needs reduction of the dislocation. The reduction techniques
such as traction-counter traction (TCT), Milch or traction, abduction and external rotation maneuver (TAE) are
performed under either sedation or without sedation. However, the reduction under sedation needs postsedative
recovery time which is a work load and makes long service time in emergency room.
Objective: To compare postreduction service time of acute anterior shoulder dislocation reduction
under sedative-free and sedation.
Patients and Methods: We reviewed medical records and radiographs of 71 acute anterior shoulder
dislocation patients. The reduction was successfully performed by TCT, Milch or TAE techniques. The patients
were divided into two groups. In Group 1 and 2 the reduction was performed under sedative-free and sedation
respectively. The sedation technique was intravenous pethidine or morphine or combination of either pethidine
or morphine with diazepam. Time from post successful reduction until the patient was discharged from
emergency room was recorded and statistically analyzed by using Student t-test. P value ≤0.05 is considered as
significant difference.
Results: There were 38 patients in group 1 and 33 patients in group 2. The average time from post
successful reduction until patient discharge from the emergency room (PD) of Group 1 was 45.08 minutes (SD,
22.99) and of Group 2 was 84.64 minutes (SD, 24.89). The statistical analysis showed that PD time of Group 1
was significantly 39.56 minutes lesser than of Group 2 (p <0.001)
Conclusions: Reduction of acute anterior shoulder dislocation under sedative-free can save more
postreduction service time than under sedation.
References
1. McNamara RM. Reduction of anterior shoulder dislocation
by scapular manipulation. Ann Emerg Med 1993;22:1140-4.
2. Harnroongroj T, Rugpolmuang P, Keatkor S. A simple
procedure for reducing anterior shoulder dislocation without
anesthesia: Traction, abduction and external rotation. Siriraj
Hosp Gaz 1999;51:153-7.
3. Kosnik J, Shamsa F, Raphael E, Huang R, Malachias Z,
Georgiadis GM. Anesthetic methods for reduction of acute
shoulder dislocations: a prospective randomized study
comparing intraarticular lidocaine with intravenous
analgesia and sedation. Am J Emerg Med 1999;17:566-70.
4. Moharari RS, Khademhosseini P, Espandar R, Soleymani HA,
Talebian MT, Khashayar P, et al. Intra-articular lidocaine
versus intravenous meperidine/diazepam in anterior shoulder
dislocation: a randomised clinical trial. Emerg Med J 2008;
25:262-4.
5. Miller SL, Cleeman E, Auerbach J, Flatow EL. Comparison of
intra-articular lidocaine and intravenous sedation for
reduction of shoulder dislocations: a randomized,
prospective study. J Bone Joint Surg Am 2002;84-A:2135-9.
6. Dunn MJ, Mitchell R, Souza CD, Drummond G. Evaluation of
propofol and remifentanil for intravenous sedation for
reducing shoulder dislocations in the emergency
department. Emerg Med J 2006;23:57-8.
7. Dunn MJ, Mitchell R, Desouza CI, Drummond GB, Waite A.
Recovery from sedation with remifentanil and propofol,
compared with morphine and midazolam, for reduction in
anterior shoulder dislocation. Emerg Med J 2010 Apr 1.
8. Russell JA, Holmes EM 3rd, Keller DJ, Vargas JH 3rd. Reduction
of acute anterior shoulder dislocations using the Milch
technique: a study of ski injuries. J Trauma 1981;21:802-4.
9. Janecki CJ, Shahcheragh GH. The forward elevation
maneuver for reduction of anterior dislocations of the
shoulder. Clin Orthop Relat Res 1982;164:177-80.
10. Cunningham N. A new drug free technique for reducing
anterior shoulder dislocations. Emerg Med (Fremantle)
2003;15:521-4.
11. Lippert FG 3rd. A modification of the gravity method of
reducing anterior shoulder dislocations. Clin Orthop Relat
Res 1982;165:259-60.
by scapular manipulation. Ann Emerg Med 1993;22:1140-4.
2. Harnroongroj T, Rugpolmuang P, Keatkor S. A simple
procedure for reducing anterior shoulder dislocation without
anesthesia: Traction, abduction and external rotation. Siriraj
Hosp Gaz 1999;51:153-7.
3. Kosnik J, Shamsa F, Raphael E, Huang R, Malachias Z,
Georgiadis GM. Anesthetic methods for reduction of acute
shoulder dislocations: a prospective randomized study
comparing intraarticular lidocaine with intravenous
analgesia and sedation. Am J Emerg Med 1999;17:566-70.
4. Moharari RS, Khademhosseini P, Espandar R, Soleymani HA,
Talebian MT, Khashayar P, et al. Intra-articular lidocaine
versus intravenous meperidine/diazepam in anterior shoulder
dislocation: a randomised clinical trial. Emerg Med J 2008;
25:262-4.
5. Miller SL, Cleeman E, Auerbach J, Flatow EL. Comparison of
intra-articular lidocaine and intravenous sedation for
reduction of shoulder dislocations: a randomized,
prospective study. J Bone Joint Surg Am 2002;84-A:2135-9.
6. Dunn MJ, Mitchell R, Souza CD, Drummond G. Evaluation of
propofol and remifentanil for intravenous sedation for
reducing shoulder dislocations in the emergency
department. Emerg Med J 2006;23:57-8.
7. Dunn MJ, Mitchell R, Desouza CI, Drummond GB, Waite A.
Recovery from sedation with remifentanil and propofol,
compared with morphine and midazolam, for reduction in
anterior shoulder dislocation. Emerg Med J 2010 Apr 1.
8. Russell JA, Holmes EM 3rd, Keller DJ, Vargas JH 3rd. Reduction
of acute anterior shoulder dislocations using the Milch
technique: a study of ski injuries. J Trauma 1981;21:802-4.
9. Janecki CJ, Shahcheragh GH. The forward elevation
maneuver for reduction of anterior dislocations of the
shoulder. Clin Orthop Relat Res 1982;164:177-80.
10. Cunningham N. A new drug free technique for reducing
anterior shoulder dislocations. Emerg Med (Fremantle)
2003;15:521-4.
11. Lippert FG 3rd. A modification of the gravity method of
reducing anterior shoulder dislocations. Clin Orthop Relat
Res 1982;165:259-60.
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Published
2011-06-30
How to Cite
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Harnroongroj T, Keeratipongpaiboon K, Lertudomphonwanit T, Harnroongroj T. Sedative-free Reduction of Acute Anterior Shoulder Dislocation Saves Postreduction Service Time in the Emergency Room. Thai J Surg [Internet]. 2011 Jun. 30 [cited 2024 Jul. 18];32(2). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/227241
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