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

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Mahshidfar B., Asgari-Darian A., Ghafouri H., Ersoy G., Yasinzadeh Md M.

BioImpacts, vol.1, no.4, pp.237-240, 2011 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 1 Issue: 4
  • Publication Date: 2011
  • Doi Number: 10.5681/bi.2011.034
  • Journal Name: BioImpacts
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.237-240
  • Keywords: Entonox®, Fentanyl, Midazolam, Procedural sedation and analgesia, Shoulder dislocation, Shoulder reduction
  • Dokuz Eylül University Affiliated: Yes


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. © 2011 by Tabriz University of Medical Sciences.