Hydrogen peroxide solutions are found in almost every operating theatre and are used by many surgical specialties, often with little knowledge of their inherent risk. We reviewed the literature and evidence related to the use of hydrogen peroxide in surgery. We found little evidence supporting the use of hydrogen peroxide solutions intraoperatively, a large number of reports of sometimes-fatal oxygen embolism and other evidence of tissue toxicity. We conclude that the use of hydrogen peroxide as an antiseptic has no direct benefit, but is associated with significant risk, and therefore should be reconsidered.

Hydrogen peroxide (HO) is commonly used in orthopaedic surgery during cemented arthroplasty and wound washouts. Its purported roles include antisepsis, haemostasis, mechanical debridement, and optimising the cement-bone interface during cementing. However, despite its apparent harmless mechanism of action, HO has been implicated in fatal and near fatal complications caused through oxygen emboli. We present a case of oxygen embolism and review the existing literature to highlight its potential risks and its lack of therapeutic value. We believe there is little role for its use in orthopaedic surgery.