The following is a summary of “Ultrasound-Guided Peripheral Nerve Blocks for Shoulder Dislocation in the Emergency Department: A Systemic Review,” published in the November 2023 issue of Emergency Medicine by Gawel et al.

Shoulder dislocations are among the most common orthopedic problems doctors see in the ED. Ultrasound-guided peripheral nerve blocks (USG-PNBs) are increasingly used in the ED to treat acute pain. However, there was a limited amount of clinical evidence to back their use for shoulder dislocation, and the evidence that is there is often contradictory. For a study, researchers sought to wrap up and rate the usefulness of USG-PNB for pain relief during closed reduction of fractured shoulders in the ED. 

A systematic literature search of the PubMed, Scopus, and Cochrane databases was done from the start of each database until September 2022. It was done according to the recommendations of the Preferred Reporting Items for Systematic Reviews and meta-analysis. They looked at clinical studies that looked at USG-PNB as a way to treat pain in injured shoulders in the emergency department. Data gathered from suitable studies included basic information about the patients, the USG-PNB approach, other pain relief methods, anesthesia regimens, clinical results, and side events. Five studies were included; all were randomized controlled trials that compared USG-PNB to rest and painkillers during surgery. 

Patient satisfaction rates were about the same for both types of pain relief (3.5 ± 0.6 out of 5), and the P-value was 0.76. Overall, shoulder reduction rates were higher (100% vs. 67%; P < 0.001), and successful reduction on the first try was higher (86% vs. 48%; P < 0.001). Patients who were given procedure sleep and painkillers did better. In all but one study, the USG-PNB groups stayed in the ED for less time. Overall, USG-PNB was linked to a lower chance of problems and bad events (3.9% vs. 24.9%; P < 0.001), especially bad lung events (0% vs. 14.7%; P < 0.001). USG-PNBs done by properly trained emergency doctors should be seen as a safe and effective option to painkillers during closed reduction of separated shoulders in the ED, especially for people who already have heart or lung problems.

Source: sciencedirect.com/science/article/abs/pii/S0736467923003189