Effect of a Preoperative Subacromial Epinephrine Injection on Visualization During Shoulder Arthroscopic Surgery: A Randomized Controlled Trial

Authors

• Shawn Feinstein
• Reese A Svetgoff
• Jordan Harmon
• Jacob Siahaan
• Daniel H Ngo
• Robert K Fullick
• Steven E Flores
• Paul G Shupe
• Bonnie P Gregory
• James M Gregory

Language

English

Publication Date

10-1-2024

Journal

Journal of Orthopaedic Surgery and Research

DOI

10.1177/23259671241278247

PMID

39399770

PMCID

PMC11468047

PubMedCentral® Posted Date

10-10-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Background: The addition of epinephrine to arthroscopic irrigation fluid has been shown to improve surgeon-rated visual clarity during shoulder arthroscopic surgery. Subacromial injections of epinephrine are also used for this purpose.

Purpose/hypothesis: To assess the influence of a preoperative subacromial epinephrine injection on surgeon visualization during subacromial shoulder arthroscopic surgery. It was hypothesized that the epinephrine injection would improve surgeon-rated visual clarity.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: A double-blind randomized controlled trial including adult patients undergoing shoulder arthroscopic surgery in the beach-chair position requiring visualization of the subacromial space was performed. Patients in the epinephrine group (n = 30) received a preoperative subacromial injection of bupivacaine and epinephrine, and those in the control group (n = 30) received a preoperative subacromial injection of bupivacaine. Epinephrine was added to the first 10 L of arthroscopic irrigation fluid in all patients. The primary outcome was surgeon-rated visual clarity throughout the procedure that was recorded at the end of the procedure using a visual analog scale (VAS) scored from 0 (worst) to 10 (best). Secondary outcomes included an increase in pump pressure during the procedure, total operative time, and the intraoperative use of blood pressure-modulating medications.

Results: Rotator cuff repair was performed in 88.3% of patients (25/30 epinephrine; 28/30 control), with multiple procedures performed in 85.0% of patients (23/30 epinephrine; 27/30 control). The VAS score for visual clarity was slightly better in the epinephrine group compared with the control group, although the difference was neither statistically nor clinically significant (8.3 ± 1.4 vs 7.5 ± 1.8, respectively; P = .09). There was no difference between the epinephrine and control groups in the need for an increase in pump pressure to improve visualization (8/30 [26.7%] vs 7/30 [23.3%], respectively; P > .99), total operative time (62.0 ± 19.4 vs 64.0 ± 30.1 minutes, respectively; P = .90), or the intraoperative use of blood pressure-modulating medications (20/30 [66.7%] vs 17/30 [56.7%], respectively; P = .60). There were no perioperative adverse events in either group.

Conclusion: The addition of a subacromial epinephrine injection before shoulder arthroscopic surgery resulted in a small improvement in visual clarity that was neither statistically nor clinically significant, with no adverse effects reported in this study.

Keywords

epinephrine, visualization, shoulder arthroscopic surgery, rotator cuff repair, beach-chair position

Comments

Registration: NCT05244525 (ClinicalTrials.gov).

Published Open-Access

yes

Recommended Citation

Feinstein, Shawn; Svetgoff, Reese A; Harmon, Jordan; et al., "Effect of a Preoperative Subacromial Epinephrine Injection on Visualization During Shoulder Arthroscopic Surgery: A Randomized Controlled Trial" (2024). Faculty, Staff and Student Publications. 3963.
https://digitalcommons.library.tmc.edu/uthmed_docs/3963