Suprascapular Nerve Block Vs. Procedural Sedation in Shoulder Reduction
Tezel et al (2014). A Comparison of Suprascapular Nerve Block and Procedural Sedation Analgesia in Shoulder Dislocation Reduction. American Journal of Emergency Medicine; 32 (2014) 549-552.
Shoulder joints are the most frequently dislocated joints seen in the Emergency Department. Reduction of shoulder joint is a necessary but painful procedure that patients must endure. Procedural sedation has become common in order to aid with analgesia during shoulder reduction. Although advantageous, procedural sedation can be time consuming and have side effects depending on the drug used.
The suprascapular nerve, which has its root in the superior branch of the brachial plexus (C5, C6), provides sensory innervation to the glenhohumeral joint and the acromioclavicular joint. Suprascapular nerve block was introduced in the 1940s and is widely used by anesthesiologists for various etiologies of shoulder pain.
Goal of the Study:
Compare outcomes of US guided suprascapular nerve block and procedural sedation using Ketamine for shoulder reduction.
Prospective single-center study performed in Istanbul, Turkey. Participants (n =41) were randomized to either the nerve block group or the sedation group once identified as having a shoulder that needed reduction.
Nerve block group- shoulder reduced after PrilocR (prilocaine 2%) was injected into suprascapular nerve under US guidance.
Sedation group- Ketamine given at 1-2 mg/kg, and if necessary a 1/3-1/2 of the dose was repeated.
In both groups, modified Kocher method was used for reduction. In cases of unsuccessful reduction, Choice of second technique left to attending physician.
No statistical difference in success of reduction
No side effects in nerve block group
Side effects observed in sedation group: nausea-vomiting (n=3), hypoxia (n=2), agitation on recovery (n=3)
Mean time to discharge in nerve block group: 25 mins
Mean time to discharge in sedation group: 125 mins
* Time to discharge is statistically difference
No statistical difference in physician-patient satisfaction score
Use of suprascapular nerve block significantly reduced time to discharge in patients with shoulder dislocations
Patient satisfaction, success of reduction were not different between two groups
Patients in sedation group had more side effects from medication
Did not use propofol, a drug that is much shorter acting than ketamine and may not have such a drastic difference in time to discharge
Study was small (n =41) performed in one ER in Turkey