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.
- Have the patient sit upright
- Position the curvilinear probe on the posterior aspect of the affected shoulder with the probe marker in the horizontal orientation
- 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
- Using ultrasound guidance, follow the needle until the needle tip is located within the joint space between the humeral head and the glenoid
- Often, patient have analgesia after a few minutes of administration
- 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