Should we be sedating all dislocated shoulders?
Whilst working at a large central London teaching hospital, I got out of
the habit of using sedation/analgesia for all. I spoke to several of the
consultants (there are rather a lot there!) and came away with a large
number of answers to the question.
Some patients had a local infiltration of lignocaine into the glenoid
cavity. Some had sedation/analgesia with Midazolam and opiate, some had
just entonox. (I did try suprascapular nerve blocks and I am pleased to
report that that is one error that I shall never make again!).
Eventually, I learnt that for many patients, turning on the charm and
getting them to relax works very well at no risk (verbatim, or talking
the shoulder in).
What I learnt from my endeavours is the following:
Patients differ. Some tolerate discomfort. Others don't. Some are
terrified. That last group benefits from Midazolam/Opiate.
Dislocations of the same joint differ. Some reduces easily, others do
not, the point of the reduction manoevre at which it reduces is often
different.
Clinicians differ. Well, we all knew that anyway.
In essence, sedation analgesia should be reserved for those patients
whom you think will need it, or for the SHO's shoulder reduction
learning curve, in which case we should be supervising them.
As for flumazenil, all I want to know is where it is just in case I
really do need it, which is very rare.
--
Stephen Hughes SpR Anything & Everything. With apologies for length of posting.
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