A Cochrane review [Abstract] 1 included 5 studies with a total of 211 subjects. There was no difference in the immediate success rate of intra-articular lidocaine (lignocaine; IAL) when compared with intravenous analgesia with or without sedation (IVAS) in the closed manual reduction of acute anterior shoulder dislocation (RR 0.95; 95% CI 0.83 to 1.10). There were significantly fewer adverse effects associated with IAL compared with IVAS (RR 0.16; 95% CI 0.06 to 0.43). The mean time spent in the emergency department was significantly less with IAL compared with IVAS (MD 109.46 minutes; 95% CI 84.60 to 134.32). One trial reported significantly less time for reduction with IVAS (105 seconds; 95% CI 84.0 to 126.1) compared with IAL (284.6 seconds; 95% CI 185.3 to 383.9). One trial reported no joint infection associated with intra-articular lignocaine injection and no mortality associated with either IAL or IVAS.
Comment: The quality of evidence is downgraded by limitations in study quality (inadequate or unclear allocation concealment) and byimprecise results (limited study size for each comparison).
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