title: Infiltration of epinephrine in reduction mammaplasty:  a systematic review of the literature.
abstract: BACKGROUND
  Evidence of the benefit of dilute epinephrine infiltration before reduction mammaplasty is provided by several controlled trials. Despite variation in operative technique and data collection, a reduction in intraoperative blood loss has been shown. The aim of this review of the literature is to weigh the available evidence with respect to reducing blood loss during surgery and other outcome measures such as postoperative drainage.
  
  
  METHODS
  Two researchers independently selected articles for review, and data were extracted from each primary article and used for statistical and descriptive comparisons.
  
  
  RESULTS
  A meta-analysis of operative blood loss showed a highly significant drop in operative blood loss in breasts infiltrated with epinephrine and a reduction in the need for blood transfusion. Operative time, postoperative drainage, and complications were not significantly affected by epinephrine infiltration.
  
  
  CONCLUSIONS
  The authors' recommendation would be for the use of dilute epinephrine infiltration before reduction mammaplasty.
authors.affiliation: Coventry, United Kingdom From the Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hardwicke
authors.forename: Robert W
authors.initials: RW
authors.lastname: Jordan
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Skillman
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007322:Instillation, Drug; D007430:Intraoperative Care / Q000379:methods*; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome; D006113:United Kingdom; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine