Anterior shoulder dislocation is a pathology frequently encountered in emergency medicine.
The success in reducing anterior shoulder dislocations depends on muscle relaxation, which is itself conditioned by the patient's pain and apprehension. However, there is no consensus on the optimal technique for reducing anterior shoulder dislocation or the analgesia associated with it.
Analgesia with METHOXYFLURANE showed a greater reduction in post-traumatic pain compared to standard analgesic treatment and faster action of METHOXYFLURANE. A retrospective study which has compared analgesia with METHOXYFLURANE and analgesic sedation with PROPOFOL found a shoulder reduction success rate of 80% and a reduction in the average length of stay in the emergency department.
Finally, the use of virtual reality in pain management is emerging in our practices by allowing pre- and per-procedure hypno-sedation-analgesia. However, the use of virtual reality headsets has not been studied in the management of anterior shoulder dislocation.
The use of these two techniques could therefore limit the use of procedural sedation in the context of shoulder dislocation reduction.
Pregnant and/or breastfeeding women and women of childbearing age who do not have effective contraception (hormonal, mechanical or surgical).
Patients with difficulties in understanding or using the devices studied.
Patients with a contraindication to the use of one of the studied devices.
Patients with a history of relevant shoulder surgery
Withdrawal of voluntary informed consent from the patient
Violation of protocol
Presence of a fracture associated with the dislocation (excluding Malgaigne's notches)
Posterior, inferior or erecta dislocation
Parallel
Helmet virtual reality.
DeviceUse of a " virtual reality " (VR) headset of " Pico G2 " type with " HypnoVR " software and audio headset " Taotronics BH22 " during all the reduction care
Administration of METHOXYFLURANE
DrugSelf administered inhalated methoxyflurane (maximal inhaled dose : 3 mL)
Standard of care
DrugAn anticipated analgesia protocol composed of PARACETAMOL 1g +/- OXYNORM 5 mg or 10 mg according to patients weight and pain intensity as evaluated by a simple numeric rating scale is administred prior to the reduction procedure. Inhaled equimolar mixture of oxygen and notrous oxyde (MEOPA) at a 15L/min flux is administered concomitantly to the reduction procedure.
Decrease in the rate of procedural sedation of anterior shoulder dislocation
Rate of use of procedural sedation for anterior shoulder dislocation reduction in the interventional groups compared to the control group
The amount of co-antalgesics administered
Posology of co-analgesic medications administered
The duration of the procedure
Time lenght of the reduction procedure
The dosage of drugs used in procedural sedation
Posology of sedative drugs administered for a procedural sedation
The average length of stay in the emergency department
Average length of stay in the emergency department
Click on the lead sponsor to view all of their trials.
