Arthroscopic shoulder surgery with epinephrine saline irrigation

To determine whether dilute epinephrine saline irrigation (0.33 mg/L) delivered by a pressure-controlled pump would significantly reduce intraoperative bleeding during routine arthroscopic shoulder surgery and, in addition, to investigate potential adverse cardiovascular reactions of adding epinephrine to the irrigation fluid.

Prospective, randomized, double-blinded, placebo-controlled study.

Fifty-four patients requiring arthroscopic shoulder surgery were randomly assigned to either an epinephrine group that received dilute epinephrine irrigation by a pressure-controlled pump or to a placebo group that received plain saline irrigation by a pressure-controlled pump. Intraoperative, intra-articular bleeding was estimated by multiplying the total volume of the irrigation fluid used with the hemoglobin concentration in the irrigation fluid. Postoperatively, the surgeon rated the clarity of the visual field during the arthroscopy by a visual analogy scale.

Intraoperative bleeding was significantly reduced (P =.008) and the clarity of the visual field was significantly better (P =.0007) in the group of patients receiving dilute epinephrine irrigation compared with the group of patients without epinephrine added to the irrigation fluid.

The addition of epinephrine to irrigation fluid seems to reduce intra-articular bleeding during routine arthroscopic shoulder surgery and may improve visualization. Furthermore, no cardiovascular adverse reactions were observed resulting from the intra-articular epinephrine administration.