Original Article With Video Illustration
Epinephrine Diluted Saline–Irrigation Fluid in Arthroscopic Shoulder Surgery: A Significant Improvement of Clarity of Visual Field and Shortening of Total Operation Time. A Randomized Controlled Trial

https://doi.org/10.1016/j.arthro.2015.08.027Get rights and content

Purpose

To determine the influence of epinephrine saline irrigation in therapeutic shoulder arthroscopy procedures on the clarity of arthroscopic view. Three subgroups were analyzed; (1) Bankart/SLAP repairs; (2) rotator cuff repairs; and (3) subacromial procedures without rotator cuff repair. Secondary objectives were to evaluate the influence on total operating time and potential cardiovascular adverse reactions.

Methods

The design of the study was a prospective, randomized, double-blind controlled trial. A total of 101 patients were included. Pressure pump−controlled regular saline irrigation fluid was used in the control group. In the epinephrine group, epinephrine (0.33 mg/L) was added to the saline-irrigation fluid. Visual clarity was rated by a Numeric Rating Scale. Total operation time, total use of irrigation fluid, increases in pump pressure, heart rate, blood pressure, and electrocautery use were registered.

Results

Visual clarity (P = .002) was significantly better and total operating time (P = .008) significantly shorter in the epinephrine group. Total irrigation fluid used was significantly lower in the epinephrine group (P = .001). The greatest effect on visual clarity and shortening of operation time up to 15 minutes was seen in Bankart and SLAP repairs. No significant effect of the addition of epinephrine on heart rate and blood pressure was observed.

Conclusions

The addition of epinephrine (0.33 mg/L) to irrigation fluid significantly improves visual clarity in most common types of therapeutic shoulder arthroscopy. A significant reduction in total operating time and use of irrigation fluid was observed. The greatest effect on visual clarity and shortening of operation time was seen in Bankart and SLAP group. Therefore, one of our initial hypotheses that the greatest effect would be observed in subacromial and rotator cuff repair procedures was not supported by the data presented. No cardiovascular adverse reactions were seen.

Level of evidence

Level 1, Randomized controlled trial.

Section snippets

Methods

After prospective power analysis and obtaining institutional review board approval, we performed a prospective randomized double-blind controlled trial to determine the influence of the addition of epinephrine to saline-irrigation fluid in therapeutic shoulder arthroscopy procedures on the visual clarity.

Patients were randomized into 2 groups: a control group and an epinephrine group. In the epinephrine group, the arthroscopy was performed with 0.33 mg of epinephrine diluted per liter of saline

Results

The data of 101 patients were analyzed. There was no difference seen in distribution between the epinephrine and the control groups concerning the subdivision into the different surgical subgroups (Fig 1). The distribution of the procedures performed in the epinephrine and the control group is shown in Table 1.

Discussion

Our study found significant improvement in visual clarity when epinephrine was added to saline-irrigation fluid during all types of therapeutic shoulder arthroscopies. The subacromial and RCR procedures did not benefit more than the intra-articular procedures. The TOT, total use of irrigation-fluid, and necessity of increasing the pressure-controlled-pump settings were reduced in the procedures performed in this study. No differences in preoperative measured vital parameters and had no

Conclusions

The addition of epinephrine (0.33 mg/L) to irrigation fluid significantly improves visual clarity in the most common types of therapeutic shoulder arthroscopy. A significant reduction in TOT and volume and use of irrigation fluid was observed. The greatest effect on visual clarity and shortening of operation time was seen in the Bankart and SLAP group. Therefore, one of our initial hypotheses that the greatest effect would be observed in the subacromial and RCR procedures was not supported by

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    The authors declare that they have no conflicts of interest in the authorship and publication of this article.

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