Ultrasound-guided interscalene block versus intravenous analgesia and sedation for reduction of first anterior shoulder dislocation

Am J Emerg Med. 2022 Jun:56:232-235. doi: 10.1016/j.ajem.2022.03.047. Epub 2022 Mar 28.


Purpose: This study aims to compare the efficacy of ultrasound-guided interscalene block (US-ISB) with that of intravenous analgesia and sedation (IVAS) in reducing first shoulder dislocation.

Material and methods: A prospective study was performed in 66 patients with first anterior shoulder dislocation in emergency department. The patients were divided into a US-ISB (n = 32) group and an IVAS (IVAS n = 34) group. The procedure time (anesthesia, reduction, and hospital times), pain score (before, during, and after reduction), reduction attempts, complications, and patient satisfaction were recorded and compared between the two groups.

Results: The anesthesia time (P < 0.01) and reduction time (P < 0.01) were shorter and the hospital time (P < 0.01) was longer in the IVAS group than in the US-ISB group. No significant differences in preoperative (P = 0.18) and postoperative (P = 0.27) pain scores were found between the two groups, but the intraoperative score of the US-ISB group was significantly higher than that of the IVAS group. More reduction attempts (P < 0.01) were recorded in the US-ISB group than that in the IVAS group. Complications (P < 0.01) such as nausea, vomiting, headache, and hypoxia occurred more frequently in the IVAS group than in the US-ISB group. No significant difference in patient satisfaction was observed between two groups (P = 0.96).

Conclusion: Compared with IVAS group, US-ISB group reduces the time to discharge and achieves lesser complication. The pain score and reduction attempt are lower in the IVAS group than in the US-ISB group.

Keywords: General anesthesia; Interscalene block; Reduction; Shoulder dislocation.

MeSH terms

  • Analgesia* / methods
  • Anesthetics, Local / therapeutic use
  • Arthroscopy / adverse effects
  • Arthroscopy / methods
  • Brachial Plexus Block* / methods
  • Humans
  • Pain / complications
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / prevention & control
  • Prospective Studies
  • Shoulder / surgery
  • Shoulder Dislocation* / complications
  • Shoulder Dislocation* / surgery
  • Ultrasonography, Interventional


  • Anesthetics, Local