Shoulder Block and Cunningham Reduction Technique
For a patient with a dislocated shoulder, the time spent at bedside is likely the most costly resource. Labs are typically not required. X-ray diagnostics are relatively inexpensive, as are medications. In a patient requiring conscious sedation, the time the physician and nursing spend at bedside can be the single greatest cost and detriment to efficiency. In a cooperative patient, there is evidence to suggest intra-articular lidocaine can replace the need for conscious sedation in shoulder reduction.1 This approach is intriguing for a multitude of reasons including probable improved safety profile, decreased manpower needs, decreased resource utilization, and improved throughput.
Here we present a case of a young man who presented shortly after fall with obvious anterior dislocation of the left shoulder. After X-ray confirmation, the patient underwent intra-articular block for analgesia in addition to IV opioids. He then was reduced with the Cunningham technique. This approach was thought ideal in the conscious patient given the decreased torsion and manipulation required by other approaches, which often induces tension and resistance from an alert patient.
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1. Warne R and Kuhn J. Intraarticular Lidocaine versus Intravenous Procedural Sedation with Narcotics and Benzodiazepines for Reduction of the Dislocated Shoulder: a Systematic Review. Academic Emergency Medicine 2008; 15:703-708