This e-mail is to update you on our research study entitled "Intra-articular Lidocaine versus Conscious Sedation for the Reduction of Anterior Shoulder Dislocations. This study has been on-going for the last 15 months. Enrollment has been incredibly slow and physicians assigned to the intra-articular lidocaine group have had mixed success. Earler this month we met with the Division of Emergency Medicine research committee and together we have come up with the following plan of action.
[B][U]Regarding Intra-articular lidocaine:[/U][/B]
We conducted another review of the literature which confirms that IAL is an effective alternative to IVS for reduction of anterior shoulder dislocations. On review of the cases in our study which required reversion to IVS, we believe our injection site recommendation was too superior resulting in the lidocaine being injected into the subacromial space instead of the glenohumeral joint.
To address this issue, we have modified the information sheet in the IAL study package and will review the anatomic marking at an up coming Grand Rounds and will attempt to review this with each of you individually. Basically, using the acromion and corocoid as markers, the injection should be 2-3cm inferior along the midway point between the 2 markers. Consider using the patient’s other shoulder to orient yourself to the humeral head (and therefore the glenoid) location. Use a 25g 1 1/2 inch needle inserted to the glenoid surface and aspirate hematoma, if possible, before injecting 20 ml of 1% lidocaine. Remember, pre-procedure analgesia for either IVS or IAL is not regulated by our protocol and we encourage you to use analgesia with all these patients.
[B][U]Regarding Slow Enrollment:[/U][/B]
We will continue to enroll patients for the next six months. Bright pink posters have been placed in the department and in your mailbox to remind you of the study. If you would prefer not to enroll patients into the study and a possible study candidate is in the department, consider asking your colleagues working at the time if they would like to see the patient so they have a chance to be recruited for the study. The primary outcome for this study is length of stay in the department and is therefore meant to determine whether this procedure (IAL) could help with patient flow. It is not intended to replace IVS. Please remember that patient confidence in their physician carries a great deal of weight in their decision to enroll in the study. While we appreciate that it is difficult to speak assertively about a procedure that you don’t feel 100% confident about, we all had a first time doing medical procedures so please give this a try!
[B][U]Location of Letter of Information and Study Envelopes[/U][/B]
The letter of information and consent forms and study envelopes are kept in the following areas:
VH: Study envelopes and consent forms are in the physician’s office room D1-646
UH: Study envelopes and consent forms are in the consult office room A1-114
UCC: Study envelopes and consent forms are on the shelf in the consultant’s area
Once you have enrolled a patient in the study, please place the completed patient and physician forms back in the study envelope and put the envelope back where you found it under the “used study envelopes” section or in Dr. Wanda Millard’s mailbox at UH or Vic. If the paperwork is left in the chart, it goes to health records and all your hard work is lost forever!
If you have any questions, comments or concerns, please feel free to email Heather (pager 13026) or Wanda (pager 13345). Alternatively, if you have questions while enrolling a patient or you can contact Shelley McLeod ext 76089.
Wanda & Heather