Ultrasound-guided interscalene block for shoulder dislocation reduction in the ED

Shoulder dislocations are often associated with significant pain, and many emergency physicians choose conscious sedation to achieve reduction. Concerns about oxygenation, airway protection, and aspiration may make some patients poor candidates for conscious sedation. Ideally, complete pain control and muscle relaxation could be achieved without airway compromise. Interscalene nerve blocks are routinely used for shoulder surgery in the operating suite. The equipment required to locate the nerve plexus blindly is typically not available in the ED setting. Recent work has shown that ultrasound guidance is ideal for the interscalene block and would make it possible in the ED. We present 4 cases of patients receiving ultrasound-guided interscalene blocks for pain control and muscle relaxation during shoulder reduction. Complete pain control, muscle relaxation, and joint reduction were achieved in each case.