Seven RCTs were identified, but one study was unobtainable and so six studies were included (n=283).
Quality: Five studies were described as level 1. One study was allocated level 2.
None of the included studies reported any significant difference between intra-articular lidocaine and intravenous sedation in reduction success or perceived pain. Ease of reduction was reported in three studies with no significant difference between the groups.
Time of reduction was reported in four studies. Three studies found onset of medication effect was faster in the intravenous sedation group.
Length of stay in the emergency department was reported in two studies. Both studies found that the intra-articular lidocaine group spent significantly less time in the department (p<0.01).
Overall there were significantly fewer complications in the intra-articular lidocaine group (Χ2 p<0.001). In the intra-articular lidocaine group included only one report (0.67%) of psychological agitation. The intravenous sedation group included 18 reports (13.3%) of nausea, vomiting or respiratory depression.
There was considerable heterogeneity between the studies. The number of prior dislocations, reduction technique and opiate/benzodiazepine combination used for intravenous sedation were highly variable.