Ultrasound-Guided Low-Volume Brachial Plexus Block in the Supraclavicular Region for Shoulder Reduction in the Emergency Department (LOW-ST-SD)

Ultrasound-Guided Low-Volume Brachial Plexus Block in the Supraclavicular Region for Shoulder Reduction in the Emergency Department: A Retrospective Monocentric Observational Study

Acute shoulder dislocation is a common and painful condition in the emergency department (ED). Procedural sedation is widely used to facilitate reduction but is associated with potential risks and resource use. Ultrasound-guided regional anesthesia has emerged as an alternative approach.

This retrospective, monocentric observational study analyzes routinely collected clinical data from an orthopedic ED between February 2018 and February 2024. Adult patients with acute shoulder dislocation are included.

The study evaluates the feasibility, safety, and clinical implementation of low-volume (approximately 5 ml local anesthetic) ultrasound-guided brachial plexus block in the supraclavicular region. Outcomes include procedural success, block-related complications, and temporal trends reflecting the adoption of the technique over time.

Study Overview

• Status: Completed
• Conditions: Shoulder Dislocation; Joint Dislocation
• Intervention / Treatment: Procedure: Ultrasound-guided brachial plexus block

Detailed Description

Acute shoulder dislocation is a frequent orthopedic emergency requiring timely reduction. Procedural sedation and analgesia (PSA) is commonly used but may be associated with risks and increased resource utilization. Ultrasound-guided regional anesthesia of the brachial plexus represents an alternative approach that may allow effective reduction without systemic sedation.

This retrospective, monocentric observational study is based on routinely collected clinical data from the orthopedic emergency department of the Merian Iselin Klinik Basel, Switzerland, covering the period from February 2018 to February 2024. All eligible patients with acute shoulder dislocation were included.

During the study period, ultrasound-guided low-volume brachial plexus block in the supraclavicular region was progressively implemented as part of routine clinical practice. The technique used a standardized low-volume approach (approximately 5 ml local anesthetic).

The aim of this study is to evaluate the feasibility and safety of this approach in a real-world setting, as well as to describe its implementation over time. Particular focus is placed on procedural success, block-related complications, and temporal trends reflecting increasing use and operator experience.

The study further explores the practical aspects of integrating this technique into routine emergency care, including its applicability across a broader group of physicians in a setting with rotating staff and limited case numbers.

The study is conducted in accordance with the Swiss Human Research Act (HRA) as a further use of health-related personal data without consent (Art. 34 HRA). All data are analyzed in coded form without additional interventions or patient contact.

• Study Type: Observational
• Enrollment (Actual): 206

Contacts and Locations

Study Locations

• Switzerland
  • Basel
    • Basel, Basel, Switzerland, 4009
      • Merian Iselin Klinik, Orthopaedic Emergency Department

Participation Criteria

Eligibility Criteria

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

• Sampling Method: Non-Probability Sample

Study Population

Patients presenting with acute shoulder dislocation to a specialized orthopedic emergency department in a single-center setting.

The study population reflects routine clinical practice, including patients treated with ultrasound-guided brachial plexus block or alternative approaches.

Description

Inclusion Criteria:

• Patients presenting with acute shoulder dislocation to the orthopedic emergency department of the Merian Iselin Klinik Basel between February 2018 and February 2024.
• Patients treated within routine clinical care with documented management of shoulder reduction.

Exclusion Criteria:

• Patients with incomplete or missing clinical documentation relevant to the study endpoints.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Patients with acute shoulder dislocation; Adult patients presenting with acute shoulder dislocation to the orthopedic emergency department between February 2018 and February 2024. Patients were treated according to routine clinical practice, including ultrasound-guided low-volume brachial plexus block or alternative approaches.	Procedure: Ultrasound-guided brachial plexus block; Ultrasound-guided low-volume brachial plexus block performed in the supraclavicular region as part of routine clinical care for shoulder reduction. The technique was applied according to operator experience and evolving clinical practice over time.; Other Names: Low-volume nerve block; Supraclavicular approach

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Successful shoulder reduction without procedural sedation	Proportion of patients in whom shoulder reduction was successfully achieved using ultrasound-guided low-volume brachial plexus block without conversion to procedural sedation or general anesthesia.	During the emergency department visit

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Block-related complications	Occurrence of complications associated with ultrasound-guided brachial plexus block as documented in routine clinical records.	During the emergency department visit
Conversion to procedural sedation	Proportion of cases requiring conversion to procedural sedation after initial attempt with regional anesthesia.	During the emergency department visit
Temporal trends in technique utilization	Change in the proportion of patients treated with ultrasound-guided brachial plexus block over time, reflecting adoption of the technique and increasing operator experience.	February 2018 to February 2024

Collaborators and Investigators

• Sponsor: Merian Iselin Klinik
• Collaborators: Bethesda Krankenhaus
• Investigators: Principal Investigator: Eckehart Schöll, MD, Bethesda Spital, Basel, Switzerland; Principal Investigator: Markus Knupp, MD, Merian Iselin Klinik, Basel, Switzerland

Publications and helpful links

General Publications

• Schöll E, Litz RJ, et al. Ultrasound-guided brachial plexus block for shoulder reduction. Presented at the Dreiländertreffen der SGUM/DEGUM/ÖGUM, 2024. DOI: 10.1055/s-0044-1789060
• Zacchilli MA, Owens BD. Epidemiology of Shoulder Dislocations Presenting to Emergency Departments in the United States: J Bone Jt Surg-Am Vol. März 2010;92(3):542-9.
• Leroux T, Wasserstein D, Veillette C, Khoshbin A, Henry P, Chahal J, u. a. Epidemiology of Primary Anterior Shoulder Dislocation Requiring Closed Reduction in Ontario, Canada. Am J Sports Med. Februar 2014;42(2):442-50.
• Blaivas M, Lyon M. Ultrasound-guided interscalene block for shoulder dislocation reduction in the ED. Am J Emerg Med. Mai 2006;24(3):293-6.
• Kanji A, Atkinson P, Fraser J, Lewis D, Benjamin S. Delays to initial reduction attempt are associated with higher failure rates in anterior shoulder dislocation: a retrospective analysis of factors affecting reduction failure. Emerg Med J. Februar 2016;33(2):130-3.
• Dimakopoulos P, Panagopoulos A, Kasimatis G, Syggelos SA, Lambiris E. Anterior Traumatic Shoulder Dislocation Associated With Displaced Greater Tuberosity Fracture: The Necessity of Operative Treatment. J Orthop Trauma. Februar 2007;21(2):104-12.
• Dunn MJG. Evaluation of propofol and remifentanil for intravenous sedation for reducing shoulder dislocations in the emergency department. Emerg Med J. 1. Januar 2006;23(1):57-8.
• Diego EBD, Diego ABD, Alcaraz AM, Tomás SN. Experience with regional anesthesia for reduction of shoulder dislocation in the emergency department.
• Underhill TJ, Wan A, Morrice M. Interscalene brachial plexus blocks in the management of shoulder dislocations. Emerg Med J. 1. September 1989;6(3):199-204.
• Tezel O, Kaldirim U, Bilgic S, Deniz S, Eyi YE, Ozyurek S, u. a. A comparison of suprascapular nerve block and procedural sedation analgesia in shoulder dislocation reduction. Am J Emerg Med. Juni 2014;32(6):549-52.
• Blaivas M, Adhikari S, Lander L. A Prospective Comparison of Procedural Sedation and Ultrasound-guided Interscalene Nerve Block for Shoulder Reduction in the Emergency Department. Acad Emerg Med. September 2011;18(9):922-7.
• Raeyat Doost E, Heiran MM, Movahedi M, Mirafzal A. Ultrasound-guided interscalene nerve block vs procedural sedation by propofol and fentanyl for anterior shoulder dislocations. Am J Emerg Med. Oktober 2017;35(10):1435-9.
• Harley JD, Harrison AK, Rao AJ. An update on regional anesthesia in shoulder surgery: a narrative review. Ann Jt. Juli 2025;10:29-29.
• Sonawane K. Implementing Precision Regional Anesthesia in an Emergency Setting: Bilateral Upper Trunk Blocks for Shoulder Reduction. Cureus [Internet]. 26. November 2025 [zitiert 19. Dezember 2025]; Verfügbar unter: https://www.cureus.com/articles/442311-implementing-precision-regional-anesthesia-in-an-emergency-setting-bilateral-upper-trunk-blocks-for-shoulder-reduction
• Schöll E, Gratza SK, Litz RJ. Bilaterale low-volume Blockade des Plexus brachialis bei beidseitiger antero-inferiorer Schulterluxation. Ultraschall Med - Eur J Ultrasound. September 2024;45(S 01):S42-S42.

Study record dates

Study Major Dates

• Study Start (Actual): February 5, 2018
• Primary Completion (Actual): February 28, 2024
• Study Completion (Actual): February 28, 2024

Study Registration Dates

• First Submitted: April 15, 2026
• First Submitted That Met QC Criteria: April 15, 2026
• First Posted (Actual): April 22, 2026

Study Record Updates

• Last Update Posted (Actual): April 24, 2026
• Last Update Submitted That Met QC Criteria: April 21, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Implementation; Emergency department; Procedural sedation; Brachial plexus block; Retrospective study; Ultrasound-guided regional anesthesia; Low-volume nerve block; Supraclavicular approach; Shoulder reduction
• Additional Relevant MeSH Terms: Shoulder Injuries; Musculoskeletal Diseases; Wounds and Injuries; Pathologic Processes; Disease Attributes; Joint Diseases; Pathological Conditions, Signs and Symptoms; Emergencies; Joint Dislocations; Shoulder Dislocation
• Other Study ID Numbers: LOW-ST-SD_2018-2024

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Data are not publicly available due to data protection regulations.

Drug and device information, study documents

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