A Pilot Study of Inhaled Low-dose Methoxyflurane to Support Cunningham Reduction of Anterior Shoulder Dislocation

Aim: The Cunningham method allows for the reduction of anterior shoulder dislocations (ASD) without procedural sedation and analgesia (PSA) in some patients. This pilot study evaluates the feasibility of investigating whether the administration of inhaled methoxyflurane (I-MEOF) increases the success rate of Cunningham reduction of ASD. Materials and Methods: Twenty patients with uncomplicated ASD underwent reduction attempts using the Cunningham method supported by I-MEOF analgesia (Cunningham/I-MEOF). Outcomes included the success rate without the requirement for PSA, emergency department length of stay (LOS), and operator and patient satisfaction. Results: Of the patients enrolled. 80% were male, median age was 38.6 years (range 18-71) and 55% were the first dislocations. 35% (8/20 patients) were successfully reduced using Cunningham/I-MEOF. The remainder of patients proceeded to successful closed reduction under PSA. 60% of operators reported good to excellent satisfaction with the process. Operators identified the primary cause of failed initial reduction attempts as inadequate muscle relaxation. 80% of patients reported good to excellent satisfaction. Patients whose initial reduction attempt with Cunningham/I-MEOF was successful had an average LOS of 149 min, compared with 216 min for those who proceeded to reduction under PSA. Conclusion: Success with ASD reduction by the Cunningham technique was marginally increased with the use of I-MEOF, although 65% of patients still required PSA to facilitate reduction. Both providers and patients found the process generally satisfactory, suggesting that early administration of analgesia is appreciated.