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

Background: Several studies report the positive effects of epinephrine saline irrigation in shoulder arthroscopy. Cardiovascular adverse effects have been described. The Wide Awake Local Anesthesia No Tourniquet limits bleeding. The aim of this study is to evaluate the effects of epinephrine saline infiltrations of the shoulder on arthroscopic visual comfort.Method: We carried out a retrospective comparative study in 2 groups of patients. 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 analog 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 carResults: We included 30 patients in group 1 and 30 patients in the control group. The mean VAS value at the end of the intervention was significantly higher in group 1 than in the control group: VAS = 10 in group 1 vs. VAS = 5 in group 2 (P < .0001) (higher is better). We also observed a significant decrease in VNRS between the 2 groups: VNRS = 0.25 in group 1 vs. VNRS = 1.00 in group 2 (P < .0001) (lower is better). The bleeding time was significantly lower in patients in group 1 (1 minute 39 seconds) compared with patients in group 2 (9 minutes 57 seconds) (P < .0001). No significant difference was demonstrated concerning the operating times, the quantity of irrigation fluid used, and the blood pressure data of the 2 groups. No adverse effects were observed.Conclusion: The infiltration of low doses of epinephrine as performed in Wide Awake Local Anesthesia No Tourniquet 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.Level of evidence: Level III; Retrospective Cohort Comparison; Treatment Study & COPY; 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.