Effect of adrenaline-containing irrigation on visual clarity during unilateral biportal endoscopic lumbar
Gardashkhan Karımzada1, Mehmet İlker Özer2, Demet Evleksiz1
11Department of Neurosurgery, Hitit University, Çorum Erol Olçok Training and Research Hospital, Çorum.
Objective:
This study aimed to evaluate the effect of adrenaline-containing irrigation on visual clarity, surgical efficiency, and perioperative hemodynamic safety during unilateral biportal endoscopic lumbar decompression (UBELD). Adrenaline has previously been successfully used by orthopedic surgeons in arthroscopic surgery, with positive effects on visual clarity observed. Achieving visual clarity in spinal endoscopic surgery is challenging. Improving visual clarity is critical for minimizing complications and achieving successful outcomes.
Methods:
A retrospective comparative study was conducted involving 61 consecutive patients who underwent single-level UBELD. Adrenaline-containing saline irrigation (1 mg/3 L saline) was administered to 29 patients, while standard saline irrigation was administered to 32 patients. Surgical duration, irrigation volume, visual clarity scores, perioperative hemodynamic parameters, and clinical outcomes were compared between the groups. Visual clarity was independently assessed by two blinded surgeons with unilateral biportal endoscopic experience using a 10-point numeric rating scale. Interrater reliability was evaluated using the intraclass correlation coefficient (ICC).
Results:
Baseline demographic and clinical characteristics were comparable between groups. The epinephrine group had significantly shorter operative times (mean 58.8 [SD 8.7] vs 71.8 [SD 9.1] minutes, p < 0.001), lower irrigation volume requirements (mean 23.4 [SD 3.0] vs 25.9 [SD 3.6] L, p = 0.003), and higher visual clarity scores (mean 8.2 [SD 1.6] vs 6.8 [SD 1.9], p = 0.002). Interrater reliability in visual clarity assessment was excellent (ICC = 0.92). No significant differences were observed between groups in perioperative mean arterial pressure, heart rate, or postoperative visual analog scale scores. A transient intraoperative hypertensive episode was observed in 1 patient in the epinephrine group, but this resolved after discontinuation of adrenaline irrigation.
Conclusions:
Adrenaline-containing irrigation was associated with improved visual clarity, reduced need for irrigation, and shorter operative duration without causing significant hemodynamic instability during UBELD surgery. Prospective randomized studies are required to confirm the independent effect of adrenaline while controlling for time- and procedure-related confounding factors.
