An Effective Treatment in the Austere Environment? A Critical Appraisal into the Use of Intra-Articular Local Anesthetic to Facilitate Reduction in Acute Shoulder Dislocation

The objective of this systematic review of the literature was to determine if intra-articular local anesthetic (IAL) is an effective treatment that could have prehospital application. A methodical search of MEDLINE, PubMed, and EMBASE databases targeted publications from January 1, 1990 until January 1, 2017. Eligible articles compared IAL with other analgesic techniques in patients 16 years or older experiencing acute glenohumeral dislocation. Reduction success, complications, and patient-reported outcome measures underwent comparison. All identified publications originated from the hospital setting. Procedural success rates ranged widely among randomized control trials comparing IAL with intravenous analgesia and sedation (IAL 48–100%, intravenous analgesia and sedation 44–100%). A pooled risk ratio [RR] favored intravenous analgesia and sedation (RR 0.91, 95% confidence interval [CI] 0.84–0.98), but there was significant inconsistency within the analysis (I2 = 75%). IAL provided lower complication rates (4/170, 2%) than intravenous analgesia and sedation (20/150, 13%) (RR 1.11, 95% CI 1.04–1.19, I2 = 63%). One trial found a clinically relevant reduction in visual analogue pain scores when comparing IAL against no additional analgesia in the first minute (IAL 21±13 mm; control 49±15 mm; P<0.001) and fifth minute (IAL 10±10 mm; control 40±14 mm, P<0.001) after reduction. The results suggest that IAL is an effective in...
Source: Wilderness and Environmental Medicine - Category: Environmental Health Source Type: research

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Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Clinical Rotations Source Type: forums
Conclusion: Intravenous dexmedetomidine infusion at ED50 (0.13 μg/kg) or ED95 (0.30 μg/kg) during induction for 10 min can prevent half or almost all EA after sevoflurane and remifentanil anesthesia during pediatric tonsillectomy and adenoidectomy.
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
Conditions:   Daytime Operation;   Nighttime Operation;   Sleep Quality;   General Anesthesia;   Circadian Rhythm Sleep Disorder Intervention:   Other: receiving operation during the day or at night Sponsor:   Shengjing Hospital Recruiting
Source: - Category: Research Source Type: clinical trials
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Source: Spine - Category: Orthopaedics Tags: RANDOMIZED TRIAL Source Type: research
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Source: Journal of Anesthesia - Category: Anesthesiology Source Type: research
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Source: Nursing Blogs at Johns Hopkins University - Category: Nursing Authors: Tags: New On the Pulse DNP nurse anesthesiology nurse anesthetist pain month Source Type: blogs
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Source: Anesthesiology - Category: Anesthesiology Source Type: research
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Source: Anesthesiology - Category: Anesthesiology Source Type: research
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Source: Postgraduate Medicine - Category: Internal Medicine Tags: Postgrad Med Source Type: research
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