Reduction of anterior shoulder dislocation in emergency department; is entonox® effective?

Introduction: An appropriate procedural sedation and analgesia (PSA) is crucial to reduce a dislocated shoulder successfully in emergency department. This study compares sedative effect of inhalational Entonox® (En) to intra-venous (IV) Midazolam plus Fentanyl (F+M). Methods: 120 patients with recurrent anterior shoulder dislocation were randomly assigned into two groups. 60 patients (group F+M) received 0.1 mg/kg IV Midazolam plus 3μg/kg IV Fentanyl and 60 patients (group En) received Entonox® with self administration face mask on an on-demand basis. Traction/counter-traction method was used to reduce the dislocated shoulder joint in both groups. Results: 48 out of 60 (80%) patients in group F+M and 6 out of 60 (10%) patients in group En had successful reduction (p 0.0001). The mean pain score reduction was 6.3 ± 1.2 for group F+M and 3 ± 0.9 for group En (p 0.0001). There was a statistically significant difference in mean patient satisfaction (assessed with Likert score) between two groups (4.45 ± 0.6 fr group F+M and 2.3 ± 1 for group En; p 0.0001). Duration of entire procedure (since the beginning of PSA up to the end of successful or unsuccessful reduction) was shorter in Group F+M, but successful reductions occurred earlier in group En. No major side effect such as airway compromise, retracted respiratory depression, or circulatory failure was occurred in any group. Conclusion: Entonox® may not be an appropriate agent to help reducing a dislocated shoulder.