Epinephrine irrigation for shoulder arthroscopy: 0.33 mg/l is not inferior to 1 mg/l. A prospective randomized...

Adding epinephrine to arthroscopic irrigation fluid is an effective and safe method for reducing bleeding and optimizing clarity of the surgical field. Systemic absorption of epinephrine can cause significant and sometimes sudden changes in cardiovascular parameters, requiring immediate pharmacological intervention to prevent serious events. This risk justifies the search for an intra-articular concentration of epinephrine that offers the best compromise between optimal clarity of the surgical field and easy control of the patient's cardiovascular parameters, thus ensuring their safety during surgery. This study aimed to compare these two concentrations in the context of arthroscopic rotator cuff surgery and to demonstrate the hypothesis of non-inferiority of the 0.33 mg/L dose on the clarity of the surgical field.

This prospective, randomized, multicenter study was conducted in a double-blind manner on two parallel groups (planned sample size: 85 patients per group) defined according to the epinephrine concentration of the arthroscopic irrigation fluid (group 1 = 1 mg/L, group 2 = 0.33 mg/L). The primary endpoint of the study was intraoperative clarity as assessed by the surgeon on a numerical rating scale (NRS) ranging from zero (total opacity) to ten (total clarity). Secondary endpoints included changes in cardiovascular parameters, hemodynamic medications administered, arthropump pressure levels, fluid volume used, duration of surgery, and adverse events. The study hypothesis was that the visual clarity of the surgical field in group 2 was not inferior to that in group 1.

Mean clarity scores were 8.5 ± 1.5 with 1 mg/L and 8.3 ± 1.9 with 0.33 mg/L. Non-inferiority was confirmed (mean difference -0.27; 97.5% one-sided CI [-0.79; +∞]; one-tailed t-test p = 0.003).

The effect obtained with epinephrine solution at a concentration of 0.33 mg/L is not inferior to that obtained with a concentration of 1 mg/L. The 0.33 mg/L concentration may therefore be considered a valid alternative in shoulder arthroscopy.

I; Therapeutic study.