Associated Director of Advanced Emergency Ultrasound Mount Sinai Medical Center Miami Beach Miami, Florida, United States
Objectives: To determine whether utilization of the supraclavicular brachial plexus block for anterior shoulder dislocation would achieve adequate anesthesia and muscle paralysis to aid in reduction.
Background: Anterior shoulder dislocation is very painful for patients and its reduction can pose a significant challenge for emergency physicians, even with procedural sedation. While the interscalene nerve block has proven helpful for the reduction of anterior shoulder dislocation, we believe that the supraclavicular brachial plexus is a more straightforward target and would provide complete anesthesia of the shoulder and necessary muscle paralysis.
Methods: In this case series of three patients with anterior shoulder dislocation, we employed the supraclavicular brachial plexus block for reduction. Two of the three patients had been signed out at change of shift with failed attempts at reduction with procedural sedation. In each patient, we used 15 ml lidocaine 2% with epinephrine, which was well under the maximal dose for ideal body weight.
Results: All three patients experienced a prompt and painless reduction of their shoulder joints. There were no complications of regional anesthesia.
Conclusions: While it appears that the supraclavicular brachial plexus block is useful for anterior shoulder dislocation, perhaps a larger case series should be performed, or even a non-inferiority trial with the interscalene to determine which method clinicians may prefer.
