Anterior Shoulder Dislocation at Emergency Department

Emergency Department Management of Anterior Shoulder Dislocation Patients

In this study, investigator will analyze the demographic characteristics of patients presenting to emergency department with Anterior Shoulder Dislocation. Investigators will document the mechanism of injury, orthopedic classification of shoulder dislocation, associated treatments, pre-procedural pain scoring, post-procedural pain scoring, as well as the duration of emergency department stay related to the preferred treatment, orthopedic consultation, and patient outcomes (discharge, admission to ward or intensive care unit, mortality). Aim of the study to investigate whether the current treatments used provide any superiority in emergency department outcomes for patients

Study Overview

• Status: Recruiting
• Conditions: Analgesia; Pain, Shoulder; Shoulder Dislocation

Detailed Description

Intravenous analgesia (Paracetamol, NSAIDs, opioids) is preferred for patients during the treatment and reduction stages of anterior shoulder dislocation. Additionally, patients may receive regional anesthesia and analgesia (lidocaine, bupivacaine). The route and dosage of analgesic administration are chosen by the attending physician managing the patient. In this study, investigators plan to observationally evaluate the analgesic management of patients without intervening in the method and dosage chosen by the primary treating physician.

Patients receiving analgesia will be chosen according to preffered treatment at emergency department. The study population will consist of patients presenting to the emergency department with shoulder dislocation who receive analgesia and fall into the following 4 treatment groups.

These 4 group will consist in:

1. ketamine group
2. interscalene nerve block group
3. suprascapular nerve block group
4. intraarticular lidocaine injection group. The study will compare these 4 treatment methods in terms of analgesia management, reduction time, comfort, and length of hospital stay for patients presenting to the emergency department with shoulder dislocation and receiving analgesia. The researcher will not interfere with the treatment decision made by the responsible physician or the treatment process

• Study Type: Observational
• Enrollment (Estimated): 140

Contacts and Locations

• Study Contact: Name: Gulsen AKCAY, Ass. Prof.; Phone Number: +905052874949; Email: gulakcay@yahoo.com.tr
• Study Contact Backup: Name: serife busra uysal, resident; Phone Number: +905321131688; Email: serifebusrauysal@gmail.com

Study Locations

• Turkey
  • Yenimahalle
    • Ankara, Yenimahalle, Turkey, 06110
      • Recruiting
      • Etlik City Hospital
      • Contact: Gulsen AKCAY, Ass. Prof.; Phone Number: +905052874949; Email: gulakcay@yahoo.com.tr
      • Sub-Investigator: ilker sirin, specialist
      • Principal Investigator: gulsen akcay, ass.prof.
      • Contact: serife busra uysal, resident; Phone Number: +905321131688; Email: serifebusrauysal@gmail.com
      • Sub-Investigator: serife busra uysal, resident
      • Sub-Investigator: bedriye muge sonmez, ass. prof
      • Sub-Investigator: huseyin bilgehan cevik, ass.prof.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Probability Sample

Study Population

patients followed at emergency department after shoulder dislocation who received analgesic treatment

Description

Inclusion Criteria:

Patients aged 18 years and older

Exclusion Criteria:

Patients who are not conscious at the time of admission and do not consent to participate in the study.

Patients who do not have follow-up in our healthcare system or cannot be followed up.

Patients with allergies to opioids or local anesthetics. Patients presenting to the emergency department with suspicion of multiple fractures and dislocations involving ≥2 different types of injuries will also be excluded from the study.

Forensic cases

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort
ketamine group; patients receiving ketamine as analgesic after shoulder dislocation
intraarticular lidocaine injection group; patients receiving intraarticular lidocaine injection as analgesic after shoulder dislocation
interscalene nerve block group; patients receiving interscalene nerve block group as analgesic after shoulder dislocation
suprascapular nerve block group; patients receiving suprascapular nerve block group as analgesic after shoulder dislocation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
shoulder reduction	succesful reduction of shoulder joint and assessment of pain before and after analgesic treatments with pain scales ( visual analogue scale, verbal pain intensity scale, PAINAD ( pain assessment in advanced dementia) scale andvisual analogue scale)	24 hours

Collaborators and Investigators

• Sponsor: Saglik Bilimleri Universitesi
• Collaborators: Ankara Etlik City Hospital
• Investigators: Study Director: gulsen akcay, ass. prof., ass. prof. of organization

Publications and helpful links

General Publications

• Buren MA, Theologis A, Zuraek A, Behrends M, Clark AJ, Leung JM. Lidocaine Infusion for the Management of Postoperative Pain and Delirium (LIMPP): protocol for a randomised control trial. BMJ Open. 2022 Jun 6;12(6):e059416. doi: 10.1136/bmjopen-2021-059416.
• Hayashi M, Kano K, Kuroda N, Yamamoto N, Shiroshita A, Kataoka Y. Comparative efficacy of sedation or analgesia methods for reduction of anterior shoulder dislocation: A systematic review and network meta-analysis. Acad Emerg Med. 2022 Oct;29(10):1160-1171. doi: 10.1111/acem.14568. Epub 2022 Aug 11.
• Gawel RJ, Grill R, Bradley N, Luong J, Au AK. Ultrasound-Guided Peripheral Nerve Blocks for Shoulder Dislocation in the Emergency Department: A Systemic Review. J Emerg Med. 2023 Nov;65(5):e403-e413. doi: 10.1016/j.jemermed.2023.05.021. Epub 2023 Jun 9.

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2024
• Primary Completion (Estimated): March 1, 2026
• Study Completion (Estimated): March 1, 2026

Study Registration Dates

• First Submitted: July 17, 2024
• First Submitted That Met QC Criteria: July 29, 2024
• First Posted (Actual): August 1, 2024

Study Record Updates

• Last Update Posted (Actual): August 1, 2024
• Last Update Submitted That Met QC Criteria: July 29, 2024
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Keywords: emergency department; shoulder dislocation; suprascapular nerve block; interscalene nerve block; intraarticular lidocaine injection
• Additional Relevant MeSH Terms: Pathologic Processes; Pain; Neurologic Manifestations; Wounds and Injuries; Disease Attributes; Joint Diseases; Musculoskeletal Diseases; Shoulder Injuries; Arthralgia; Emergencies; Shoulder Pain; Joint Dislocations; Shoulder Dislocation
• Other Study ID Numbers: anterior shoulder dislocation

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No