#EMConf: Blocks


Background: Ultrasound is a great alternative to conscious sedation in the emergency department when you suspect a patient has a shoulder dislocation. Conscious sedation has risks of aspiration, apnea, nausea, and vomiting. It is a procedure that requires a lot of nursing and monitoring. Intra-articular lidocaine is a great alternative in the appropriate patient and someone who is willing to try this over conscious sedation. It requires less nursing and patients have quicker discharges.





  1. Have the patient sit upright
  2. Position the curvilinear probe on the posterior aspect of the affected shoulder with the probe marker in the horizontal orientation
  3. Draw 10-20cc of 1% lidocaine in a syringe connected to IV tubing that is connected to a spinal needle, occasionally you will aspirate blood which is also a sign that you are in the joint space
  4. Using ultrasound guidance, follow the needle until the needle tip is located within the joint space between the humeral head and the glenoid
  5. Often, patient have analgesia after a few minutes of administration
  6. Now, use the shoulder reduction technique that you like and are more familiar with







Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care, Chapter 49, 980-1026.e3