Injection of lignocaine into a dislocated shoulder joint versus injection of a pain-relieving drug with or without injection of a sedative drug into a vein for the purpose of manual manipulation of acute (less than 48 hours old) anterior (towards the fron

Joint dislocation refers to displacement of the bones which form a joint away from their anatomical position. The shoulder is the most commonly dislocated joint managed in the emergency department (ED). When the dislocation occurs towards the front of the body, this is known as an anterior shoulder dislocation. It is called an acute anterior shoulder dislocation if the dislocation occurred with the previous 48 hours. Manually manipulating the displaced bones back to their normal position (manual reduction) is very painful. To allow for manual reduction, pain relief can be achieved either by injecting a local anaesthetic drug (for example, lignocaine) into the dislocated shoulder joint (intra-articular lignocaine injection); or by injecting a pain killer with or without a sedative directly into the bloodstream through a vein (intravenous analgesia). The review authors searched the medical literature and identified five studies comparing these two methods. The studies included 211 patients with acute anterior shoulder dislocation; 113 patients underwent intra-articular lignocaine injection and 98 underwent intravenous analgesia with sedation. The review found that there may be no difference in the immediate success of manual reduction of the dislocated shoulder between patients receiving intra-articular lignocaine injection and those who received intravenous analgesia and sedation. However, intra-articular lignocaine injection may be associated with fewer side effects and a shorter stay in the emergency department before discharge from hospital. Compared with intravenous analgesia and sedation, intra-articular lignocaine may also be cheaper. However, the relatively small number of studies included in the review and the relatively small number of patients in each study means that the results of the review preclude definitive conclusions regarding the superiority of either method..