Ultrasound-Guided Low-Volume Brachial Plexus Block in the Supraclavicular Region for Shoulder Reduction in the Emergency Department

NCT07544485 | Completed

• 1 other identifier: LOW-ST-SD_2018-2024
• Study Type: observational
• Target: 206
• Locations: 1 country
• Sites: 1

Brief Summary

Acute shoulder dislocation is a common and painful condition in the emergency department (ED). Procedural sedation is widely used to facilitate reduction but is associated with potential risks and resource use. Ultrasound-guided regional anesthesia has emerged as an alternative approach. This retrospective, monocentric observational study analyzes routinely collected clinical data from an orthopedic ED between February 2018 and February 2024. Adult patients with acute shoulder dislocation are included. The study evaluates the feasibility, safety, and clinical implementation of low-volume (approximately 5 ml local anesthetic) ultrasound-guided brachial plexus block in the supraclavicular region. Outcomes include procedural success, block-related complications, and temporal trends reflecting the adoption of the technique over time.

Conditions

Shoulder Dislocation; Joint Dislocation

Keywords

Ultrasound-guided regional anesthesia; Brachial plexus block; Low-volume nerve block; Supraclavicular approach; Shoulder reduction; Emergency department; Procedural sedation; Retrospective study; Implementation

Outcome Measures

Primary Outcomes (1)

• Successful shoulder reduction without procedural sedation

  Proportion of patients in whom shoulder reduction was successfully achieved using ultrasound-guided low-volume brachial plexus block without conversion to procedural sedation or general anesthesia.

  During the emergency department visit

Secondary Outcomes (3)

• Block-related complications

  During the emergency department visit

• Conversion to procedural sedation

  During the emergency department visit

• Temporal trends in technique utilization

  February 2018 to February 2024

Study Arms (1)

Patients with acute shoulder dislocation

Adult patients presenting with acute shoulder dislocation to the orthopedic emergency department between February 2018 and February 2024. Patients were treated according to routine clinical practice, including ultrasound-guided low-volume brachial plexus block or alternative approaches.

Procedure: Ultrasound-guided brachial plexus block

Interventions

Ultrasound-guided brachial plexus block PROCEDURE

Ultrasound-guided low-volume brachial plexus block performed in the supraclavicular region as part of routine clinical care for shoulder reduction. The technique was applied according to operator experience and evolving clinical practice over time.

Also known as: Low-volume nerve block, Supraclavicular approach

Patients with acute shoulder dislocation

Eligibility Criteria

• Age: 15 Years+
• Sex: all
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients presenting with acute shoulder dislocation to a specialized orthopedic emergency department in a single-center setting. The study population reflects routine clinical practice, including patients treated with ultrasound-guided brachial plexus block or alternative approaches.

You may qualify if:

• Patients presenting with acute shoulder dislocation to the orthopedic emergency department of the Merian Iselin Klinik Basel between February 2018 and February 2024.
• Patients treated within routine clinical care with documented management of shoulder reduction.

You may not qualify if:

• Patients with incomplete or missing clinical documentation relevant to the study endpoints.

Sponsors & Collaborators

• Merian Iselin Klinik: lead
• Bethesda Krankenhaus: collaborator

Study Sites (1)

Merian Iselin Klinik, Orthopaedic Emergency Department

Basel, Basel, 4009, Switzerland

Location

Related Publications (15)

• Schöll E, Litz RJ, et al. Ultrasound-guided brachial plexus block for shoulder reduction. Presented at the Dreiländertreffen der SGUM/DEGUM/ÖGUM, 2024. DOI: 10.1055/s-0044-1789060

  BACKGROUND

• Zacchilli MA, Owens BD. Epidemiology of Shoulder Dislocations Presenting to Emergency Departments in the United States: J Bone Jt Surg-Am Vol. März 2010;92(3):542-9.

  BACKGROUND

• Leroux T, Wasserstein D, Veillette C, Khoshbin A, Henry P, Chahal J, u. a. Epidemiology of Primary Anterior Shoulder Dislocation Requiring Closed Reduction in Ontario, Canada. Am J Sports Med. Februar 2014;42(2):442-50.

  BACKGROUND

• Blaivas M, Lyon M. Ultrasound-guided interscalene block for shoulder dislocation reduction in the ED. Am J Emerg Med. Mai 2006;24(3):293-6.

  BACKGROUND

• Kanji A, Atkinson P, Fraser J, Lewis D, Benjamin S. Delays to initial reduction attempt are associated with higher failure rates in anterior shoulder dislocation: a retrospective analysis of factors affecting reduction failure. Emerg Med J. Februar 2016;33(2):130-3.

  BACKGROUND

• Dimakopoulos P, Panagopoulos A, Kasimatis G, Syggelos SA, Lambiris E. Anterior Traumatic Shoulder Dislocation Associated With Displaced Greater Tuberosity Fracture: The Necessity of Operative Treatment. J Orthop Trauma. Februar 2007;21(2):104-12.

  BACKGROUND

• Dunn MJG. Evaluation of propofol and remifentanil for intravenous sedation for reducing shoulder dislocations in the emergency department. Emerg Med J. 1. Januar 2006;23(1):57-8.

  BACKGROUND

• Diego EBD, Diego ABD, Alcaraz AM, Tomás SN. Experience with regional anesthesia for reduction of shoulder dislocation in the emergency department.

  BACKGROUND

• Underhill TJ, Wan A, Morrice M. Interscalene brachial plexus blocks in the management of shoulder dislocations. Emerg Med J. 1. September 1989;6(3):199-204.

  BACKGROUND

• Tezel O, Kaldirim U, Bilgic S, Deniz S, Eyi YE, Ozyurek S, u. a. A comparison of suprascapular nerve block and procedural sedation analgesia in shoulder dislocation reduction. Am J Emerg Med. Juni 2014;32(6):549-52.

  BACKGROUND

• Blaivas M, Adhikari S, Lander L. A Prospective Comparison of Procedural Sedation and Ultrasound-guided Interscalene Nerve Block for Shoulder Reduction in the Emergency Department. Acad Emerg Med. September 2011;18(9):922-7.

  BACKGROUND

• Raeyat Doost E, Heiran MM, Movahedi M, Mirafzal A. Ultrasound-guided interscalene nerve block vs procedural sedation by propofol and fentanyl for anterior shoulder dislocations. Am J Emerg Med. Oktober 2017;35(10):1435-9.

  BACKGROUND

• Harley JD, Harrison AK, Rao AJ. An update on regional anesthesia in shoulder surgery: a narrative review. Ann Jt. Juli 2025;10:29-29.

  BACKGROUND

• Sonawane K. Implementing Precision Regional Anesthesia in an Emergency Setting: Bilateral Upper Trunk Blocks for Shoulder Reduction. Cureus [Internet]. 26. November 2025 [zitiert 19. Dezember 2025]; Verfügbar unter: https://www.cureus.com/articles/442311-implementing-precision-regional-anesthesia-in-an-emergency-setting-bilateral-upper-trunk-blocks-for-shoulder-reduction

  BACKGROUND

• Schöll E, Gratza SK, Litz RJ. Bilaterale low-volume Blockade des Plexus brachialis bei beidseitiger antero-inferiorer Schulterluxation. Ultraschall Med - Eur J Ultrasound. September 2024;45(S 01):S42-S42.

  BACKGROUND

MeSH Terms

Conditions

Shoulder Dislocation; Joint Dislocations; Emergencies

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases; Wounds and Injuries; Shoulder Injuries; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Eckehart Schöll, MD

  Bethesda Spital, Basel, Switzerland

  PRINCIPAL INVESTIGATOR

• Markus Knupp, MD

  Merian Iselin Klinik, Basel, Switzerland

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 15, 2026
• First Posted: April 22, 2026
• Study Start: February 5, 2018
• Primary Completion: February 28, 2024
• Study Completion: February 28, 2024
• Last Updated: April 24, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

CH (1)