Ultrasound-guided interscalene nerve block vs procedural sedation by propofol and fentanyl for anterior shoulder dislocations
| Autor: | Amirhossein Mirafzal, Mohammad Mehdi Heiran, Mitra Movahedi, Esmaeil Raeyat Doost |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Epinephrine Sedation medicine.medical_treatment Conscious Sedation Fentanyl 03 medical and health sciences Young Adult 0302 clinical medicine 030202 anesthesiology medicine Humans Anesthetics Local Propofol Ultrasonography Interventional Brachial plexus block business.industry Shoulder Dislocation Lidocaine 030208 emergency & critical care medicine General Medicine Anterior shoulder Emergency department Brachial Plexus Block Surgery Anesthesia Procedural sedation and analgesia Emergency Medicine Nerve block Manipulation Orthopedic Female medicine.symptom business Emergency Service Hospital Anesthetics Intravenous medicine.drug |
| Zdroj: | The American journal of emergency medicine. 35(10) |
| ISSN: | 1532-8171 |
| Popis: | Few studies were performed to compare ultrasound guided brachial plexus block with procedural sedation for reduction of shoulder dislocations in the Emergency Department (ED). This study was done to provide further evidence regarding this comparison.This was a randomized clinical trial performed on patients presenting with anterior shoulder dislocations to the emergency department of an academic level 2 trauma center. Exclusion criteria were any contraindications to the drugs used, any patient which may not be potentially assigned into both groups because of an underlying medical condition, presence of neurovascular compromise related to the dislocation, presence of concomitant fractures, and patient refusal to participate in the study. Patients were randomly assigned into the Procedural Sedation and Analgesia (PSA) group with propofol and fentanyl or ultrasound guided Inter-Scalene Brachial Plexus Block (ISBPB) with lidocaine and epinephrine.A total of 60 patients (30 in each group) were included in the study. The emergency room length of stay was significantly lower in the ISBPB group, with mean (SD) values of 108.6 (42.1) vs. 80.2 (25.2) minutes (p=0.005). However, pain scores in the PSA group during reduction showed advantage over ISBPB [0.38 vs. 3.43 (p0.001)]. Moreover, patient satisfaction was higher with PSA (p0.001).Using ISBPB for reduction of anterior shoulder dislocations takes less time to discharge and may make it more feasible in conditions mandating faster discharge of the patient. However, since pain scores may be lower using PSA, this method may be preferred by many physicians in some other situations. |
| Databáze: | OpenAIRE |
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