Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Anterior shoulder dislocations (ASD) represent a common and painful orthopedic injury in the emergency department (ED). The management of ASD varies broadly from manual reductions via scapular manipulation with or without pain medication to procedural sedation and anesthesia (PSA), and various regional anesthesia (RA) techniques. The reduction approach often depends on the patient’s subjective pain response, the expected difficulty of reduction, and the physician’s experience with each method. Of the anesthetic options for difficult shoulder reductions, we generally favor RA techniques over PSA. While several RA techniques have been discussed in the literature, one technique that has yet to be analyzed is the supraclavicular brachial plexus nerve block (SBP). We believe there is evidence to suggest that the SBP would serve as an excellent anesthetic option for patients with ASD and significant pain or an expected difficult reduction.