Thirty-two patients with acute anterior shoulder dislocation were randomized to FARES (n = 17) or Spaso (n = 15) reduction without sedation. The primary outcome was first-attempt (≤2 tries) success. Secondary outcomes included overall success when switching to the alternative method after two failures, reduction time, peri-reduction VAS pain, and follow-up events (recurrence, surgery). Outcomes were assessed during the ED visit and at a mean 5.3 ± 2.2 years. Overall, the results revealed similar first-attempt success, but when FARES failed initially, switching to Spaso yielded 100% overall success in that arm, whereas switching from Spaso to FARES yielded no additional successes. Pain decreased during and after reduction in both groups, with no significant between-group differences; reduction times were also similar. These findings suggest both techniques are effective without anesthesia, and a pragmatic sequential strategy beginning with either method—but especially switching to Spaso after a failed FARES attempt—may maximize success before resorting to sedation.