Evaluation of intraoperative bleeding in shoulder arthroscopy with preoperative injection of epinephrine saline: a retrospective comparative study.

Abstract

Several studies report the positive effects of epinephrine saline irrigation in shoulder arthroscopy3,4,15,18,22,23. Cardiovascular adverse effects have been described1,2,5,6,7,9,19. The Wide Awake Local Anesthesia No Tourniquet (WALANT) limits bleeding13,16,24,25. The aim of this study is to evaluate the effects of epinephrine saline infiltrations of the shoulder on arthroscopic visual comfort. We carried out a retrospective comparative study composed of 2 groups. We included all patients admitted to the department for a rotator cuff surgery. Our exclusion criteria were any other surgical indication and patient refusal. The protocol consisted in making 3 preoperative shoulder infiltrations of 20 ml of epinephrine saline at 0.005 mg/mL. Injections were performed in all patients in group 1 and no specific treatment was performed in group 2 (control group). Data collection was performed the same way in both groups. The main judgment criterion was the evaluation of the surgeon's overall visual comfort using the Visual Analogue Scale (VAS) at the end of the procedure. We also evaluated the intraoperative discomfort related to bleeding every 15 minutes by an objective scale (the Visual Numeric Rating Scale VNRS), as well as the cumulative bleeding time, operating time, the quantity of irrigation fluid used, the blood pressure at the times of the bleeding, the mean blood pressure during the surgery and the presence of thromboembolic and cardiovascular adverse events. We included 30 patients in group 1 and 30 patients in the control group. The mean VAS value at the end of the intervention is significantly higher in group 1 than in the control group: VAS = 10 in group 1 versus VAS = 5 in group 2 (p<0.0001) (higher is better). We also observed a significant decrease in VNRS between the two groups: VNRS = 0.25 in group 1 versus VNRS = 1,00 in group 2 (p<0.0001) (lower is better). Bleeding time was significantly lower in patients in group 1 (1min 39s) compared to patients in group 2 (9min 57s) (p<0.0001). No significant difference was demonstrated concerning the operating times, the quantity of irrigation fluid used and the blood pressure data of the two groups. No adverse effects were observed. The infiltration of low doses of adrenaline as performed in WALANT procedures seems effective in improving visualization in arthroscopy by reducing the bleeding. It can be a simple, efficient, and cost-effective technique with no iatrogenic risk to improve the surgeon's comfort in arthroscopic procedures.