title: Surgeon-rated visualization in shoulder arthroscopy: a randomized blinded controlled trial comparing irrigation fluid with and without epinephrine.
abstract: OBJECTIVE
  The objective of the current study was to compare surgeon-rated visualization in shoulder arthroscopy using irrigation fluid with and without epinephrine.
  
  
  METHODS
  Eighty-three patients were randomized to receive irrigation fluid with (44 patients) or without (39 patients) epinephrine during their arthroscopic shoulder procedures. After each procedure, the blinded senior author (G.F.C.) evaluated visualization based on a visual analog scale (VAS), and all clinically important procedure variables were recorded.
  
  
  RESULTS
  Eighty-three arthroscopic shoulder procedures were included in the study. Fifty-four of these procedures were arthroscopic rotator cuff repairs, allowing a subset analysis of this specific procedure. There was a significant difference, with improved visualization in the epinephrine group versus the group without epinephrine when comparing all procedures (P < .0001) and when comparing only rotator cuff repairs (P < .0001). However, there was no statistical difference in other clinically important variables, including operative time and amount of irrigation fluid used.
  
  
  CONCLUSIONS
  The addition of epinephrine to irrigation fluid significantly improves surgeon-rated visualization in shoulder arthroscopy. Without an observed significant difference in operative time or volume of irrigation fluid used, the clinical significance of this improved visualization is unclear, and the use of irrigation fluid without epinephrine remains a viable option in the hands of an experienced surgeon.
  
  
  METHODS
  Level I, high-quality randomized controlled trial with statistically significant difference.
authors.affiliation: St. Luke's Orthopaedic Specialists, St. Luke's University Hospital, Bethlehem, PA, U.S.A.. Electronic address: daniel.avery@sluhn.org.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Avery
authors.affiliation: St. Luke's Orthopaedic Specialists, St. Luke's University Hospital, Bethlehem, PA, U.S.A.
authors.forename: Brett W
authors.initials: BW
authors.lastname: Gibson
authors.affiliation: St. Luke's Orthopaedic Specialists, St. Luke's University Hospital, Bethlehem, PA, U.S.A.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Carolan
mesh_terms: D000328:Adult; D001178:Arthroplasty; D001182:Arthroscopy / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007552:Isotonic Solutions / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D000077325:Ringer's Lactate; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012782:Shoulder / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery*; D018709:Statistics, Nonparametric; D007507:Therapeutic Irrigation / Q000379:methods*
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D004837:Epinephrine