title: Epinephrine Diluted Saline-Irrigation Fluid in Arthroscopic Shoulder Surgery: A Significant Improvement of Clarity of Visual Field and Shortening of Total Operation Time. A Randomized Controlled Trial.
abstract: OBJECTIVE
  To determine the influence of epinephrine saline irrigation in therapeutic shoulder arthroscopy procedures on the clarity of arthroscopic view. Three subgroups were analyzed; (1) Bankart/SLAP repairs; (2) rotator cuff repairs; and (3) subacromial procedures without rotator cuff repair. Secondary objectives were to evaluate the influence on total operating time and potential cardiovascular adverse reactions.
  
  
  METHODS
  The design of the study was a prospective, randomized, double-blind controlled trial. A total of 101 patients were included. Pressure pump-controlled regular saline irrigation fluid was used in the control group. In the epinephrine group, epinephrine (0.33 mg/L) was added to the saline-irrigation fluid. Visual clarity was rated by a Numeric Rating Scale. Total operation time, total use of irrigation fluid, increases in pump pressure, heart rate, blood pressure, and electrocautery use were registered.
  
  
  RESULTS
  Visual clarity (P = .002) was significantly better and total operating time (P = .008) significantly shorter in the epinephrine group. Total irrigation fluid used was significantly lower in the epinephrine group (P = .001). The greatest effect on visual clarity and shortening of operation time up to 15 minutes was seen in Bankart and SLAP repairs. No significant effect of the addition of epinephrine on heart rate and blood pressure was observed.
  
  
  CONCLUSIONS
  The addition of epinephrine (0.33 mg/L) to irrigation fluid significantly improves visual clarity in most common types of therapeutic shoulder arthroscopy. A significant reduction in total operating time and use of irrigation fluid was observed. The greatest effect on visual clarity and shortening of operation time was seen in Bankart and SLAP group. Therefore, one of our initial hypotheses that the greatest effect would be observed in subacromial and rotator cuff repair procedures was not supported by the data presented. No cardiovascular adverse reactions were seen.
  
  
  METHODS
  Level 1, Randomized controlled trial.
authors.affiliation: Haga ziekenhuis, The Hague, The Netherlands. Electronic address: douwevanmontfoort@gmail.com.
authors.forename: Douwe O
authors.initials: DO
authors.lastname: van Montfoort
authors.affiliation: Haga ziekenhuis, The Hague, The Netherlands.
authors.forename: Paulien M
authors.initials: PM
authors.lastname: van Kampen
authors.affiliation: Haga ziekenhuis, The Hague, The Netherlands.
authors.forename: Pol E
authors.initials: PE
authors.lastname: Huijsmans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001178:Arthroplasty / Q000379:methods*; D001182:Arthroscopy / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D012965:Sodium Chloride / Q000008:administration & dosage; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents; D012965:Sodium Chloride; D004837:Epinephrine