Comparison of the effects of two concentrations of adrenaline (0.33 mg/l versus 1 mg/l) in the irrigation serum for arthroscopic shoulder surgery: protocol of a randomized controlled trial

Authors

  • Edouard Harly Clinique de l’Atlantique, Ramsay Santé, Puilboreau, France
  • Anselme Billaud Clinique du Sport, Mérignac, France
  • Hugues Demezon Polyclinique Jean Villar, Elsan, Bruges, France
  • Thierry Joudet Clinique Chirurgicale du Libournais, Libourne, France
  • Clément Tournier Hôpital Privé Saint Martin, Allée des Tulipes, Pessac, France
  • Antony Pincin Centre Hospitalier François Mitterrand, Pau, France

DOI:

https://doi.org/10.18203/2349-3259.ijct20240966

Keywords:

Adrenaline, Clinical trial, Shoulder arthroscopy

Abstract

Background: Controlling bleeding during arthroscopic shoulder surgery helps improve the clarity of the arthroscopic visual field. Adrenaline is considered an effective and safe method to reduce bleeding. Two doses of adrenaline (0.33 mg/l and 1 mg/l) have been evaluated in the literature, but never against each other.

Methods: This prospective, double-blind, randomized controlled trial will study the clarity of the visual field using a numerical scale (NS) during rotator cuff surgery on 180 patients across 5 centres. The secondary objectives include: the duration of the operation, volume of saline used, increase in baseline pressure, number of arthropump hyperpressures, mean systolic blood pressure and heart rate, as well as sudden variability.

Results: Among the 154 patients in the Clinical Trial Group, 70/154 (45%) continued to have proteinuria, while 84/154 (55%) had no proteinuria (remission) compared to 41 (28%) in remission and 104 (72%) with continued proteinuria in the Usual Care group (p<0.001).

Conclusions: This study aims to determine which of the two dosages previously studied in the literature (0.33 mg/l versus 1 mg/l) provides better clarity.

Trial Registration Number: 2021-A02773-38. 

References

Hughes JD, Hughes JL, Bartley JH, Hamilton WP, Brennan KL. Infection Rates in Arthroscopic Versus Open Rotator Cuff Repair. Orthop J Sports Med. 2017;5(7):2325967117715416.

Godenèche A, Nové-Josserand L, Audebert S, et al. Relationship between subscapularis tears and injuries to the biceps pulley. Knee Surg Sports Traumatol Arthrosc. 2017;25(7):2114-2120.

Rains DD, Rooke GA, Wahl CJ. Pathomechanisms and complications related to patient positioning and anesthesia during shoulder arthroscopy. Arthroscopy. 2011;27(4):532-41.

Derriks JHG, Hilgersom NFJ, Middelkoop E, Samuelsson K, van den Bekerom MPJ. Electrocautery in arthroscopic surgery: intra-articular fluid temperatures above 43 °C cause potential tissue damage. Knee Surg Sports Traumatol Arthrosc. 2020;28(7):2270-8.

Kuo LT, Chen CL, Yu PA, Hsu WH, Chi CC, Yoo JC. Epinephrine in irrigation fluid for visual clarity in arthroscopic shoulder surgery: a systematic review and meta-analysis. Int Orthop. 2018;42(12):2881-9.

Jensen KH, Werther K, Stryger V, Schultz K, Falkenberg B. Arthroscopic shoulder surgery with epinephrine saline irrigation. Arthroscopy. 2001;17(6):578-81.

Abrons RO, Ellis SE. Severe refractory hypertension during shoulder arthroscopy. Saudi J Anaesth. 2016;10(2):236-7.

Belkin NS, Degen RM, Liguori GA, Kelly BT. Epinephrine-induced pulmonary edema during hip arthroscopy: a report of two cases and a review of the literature. Phys Sportsmed. 2017;45(3):353-6.

Cho SH, Yi JW, Kwack YH, Park SW, Kim MK, Rhee YG. Ventricular tachycardia during arthroscopic shoulder surgery: a report of two cases. Arch Orthop Trauma Surg. 2010;130(3):353-6.

Gharabawy R, Pothula VR, Rubinshteyn V, Silverberg M, Gave AA. Epinephrine-induced posterior reversible encephalopathy syndrome: a case report. J Clin Anesth. 2011;23(6):505-7.

Gicquel-Schlemmer B, Beller JP, Mchalwat A, Gicquel P. Fatal Takotsubo cardiomyopathy due to epinephrine in shoulder arthroscopy. Orthop Traumatol Surg Res. 2015;101(8):981-2.

Karns JL. Epinephrine-induced potentially lethal arrhythmia during arthroscopic shoulder surgery: a case report. AANA J. 1999;67(5):419-21.

Kounis NG, Soufras GD. Shoulder arthroscopy and ATAK (adrenaline, Takotsubo, anaphylaxis, and Kounis hypersensitivty-associated syndrome). Orthop Traumatol Surg Res. 2016;102(2):273-4.

Mazzocca AD, Meneghini RM, Chhablani R, Badrinath SK, Cole BJ, Bush-Joseph CA. Epinephrine-induced pulmonary edema during arthroscopic knee surgery. A case report. J Bone Joint Surg Am. 2003;85(5):913-5.

Avery DM, Gibson BW, Carolan GF. Surgeon-rated visualization in shoulder arthroscopy: a randomized blinded controlled trial comparing irrigation fluid with and without epinephrine. Arthroscopy. 2015;31(1):12-8.

van Montfoort DO, van Kampen PM, Huijsmans PE. 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. Arthroscopy. 2016;32(3):436-44.

Veado MA de C, Teixeira B de S, Castro NC de, Costa LA. Is it advantageous to add epinephrine to the arthroscopic infusion solution for the treatment of rotator cuff injury? Rev Bras Ortop. 2013;48(3):268-71.

Lands V, Avery DM, Malige A, Stoltzfus J, Gibson BW, Carolan GF. Rating visualization in shoulder arthroscopy: A comparison of the visual analog scale versus a novel shoulder arthroscopy grading scale. J Orthop Allied Sci. 2019;(7):8-11.

Villatte G, Erivan R, Barth J, Bonnevialle N, Descamps S, Boisgard S. Progression and projection for shoulder surgery in France, 2012-2070: Epidemiologic study with trend and projection analysis. Orthop Traumatol Surg Res. 2020;106(6):1067-77.

Liem D, Alci S, Dedy N, Steinbeck J, Marquardt B, Möllenhoff G. Clinical and structural results of partial supraspinatus tears treated by subacromial decompression without repair. Knee Surg Sports Traumatol Arthrosc. 2008;16(10):967-72.

Slenker NR, Lawson K, Ciccotti MG, Dodson CC, Cohen SB. Biceps tenotomy versus tenodesis: clinical outcomes. Arthroscopy. 2012;28(4):576-82.

Valenti P. Arthroscopic subacromial decompression. Chir Main. 2006;25(1):S22-8.

Flurin PH, Landreau P, Gregory T, Boileau P, Brassart N, Courage O, et al. Arthroscopic repair of full-thickness cuff tears: a multicentric retrospective study of 576 cases with anatomical assessment]. Rev Chir Orthop Reparatrice Appar Mot. 2005;91(S8):31-42.

Flurin PH, Landreau P, Gregory T, Boileau P, Lafosse L, Guillo S, et al. Cuff Integrity After Arthroscopic Rotator Cuff Repair: Correlation With Clinical Results in 576 Cases. Arthroscopy. 2007;23(4):340-6.

Boileau P, Baba M, McClelland WB, Thélu CÉ, Trojani C, Bronsard N. Isolated loss of active external rotation: a distinct entity and results of L’Episcopo tendon transfer. J Shoulder Elbow Surg. 2018;27(3):499-509.

Porcellini G, Castagna A, Cesari E, Merolla G, Pellegrini A, Paladini P. Partial repair of irreparable supraspinatus tendon tears: clinical and radiographic evaluations at long-term follow-up. J Shoulder Elbow Surg. 2011;20(7):1170-7.

Flurin PH. Directly suturable rotator cuff tears: arthroscopic repair techniques Directly suturable rotator cuff tears: arthroscopic repair techniques. In: Hulet C, Potel JF, D’Arthroscopie SF, editors. L’arthroscopie. Elsevier Masson. 2015:263-76.

Lenoir T, Jouve F, Desmoineaux P, Beaufils P. Interest in adding adrenaline to the irrigation serum for shoulder arthroscopies. About a prospective randomized study. Revue de Chirurgie Orthopédique et Réparatrice de l’Appareil Moteur. 2007;93(7):32.

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Published

2024-04-24