Turbulence control as a factor in improving visualization during subacromial shoulder arthroscopy

Burkhart, Stephen S.; Danaceau, Steven M.; Athanasiou, Kyriacos A.

doi:10.1053/jars.2001.22298

Cited by 50 publications

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“…[1,2] Therefore, several hemostatic techniques, including hypotensive anesthesia, electrocauterization, and use of pressure-or flow-controlled pumps, are utilized to prevent intraoperative bleeding and to obtain sufficient visualization during the arthroscopic surgical procedures. [3][4][5] Recently, a number of clinical trials have supported the use of irrigation fluid with Objectives: This study aims to investigate whether there was a difference between epinephrine (EPN) and tranexamic acid (TXA) in providing visual clarity during arthroscopic rotator cuff tear repair.Patients and methods: This double-blind, prospective, randomized-controlled clinical study included a total of 90 patients (42 males, 48 females; mean age: 55.6±8.3 years; range, 18 to 69 years) in whom either EPN (EPN group, n=47) or TXA-diluted irrigation solutions (TXA group, n=43) were used during rotator cuff tear arthroscopy between December 2017 and November 2019. Arthroscopy was performed using irrigation fluid containing 0.33 mg of EPN per 1 L of saline in the EPN group and 0.42 mg of TXA per 1 L of saline in the TXA group.…”

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Comparison of the efficacy of irrigation with epinephrine or tranexamic acid on visual clarity during arthroscopic rotator cuff repair: A double-blind, randomized-controlled study

Bayram

2021

Jt Dis Relat Surg

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Over the past decade, arthroscopic repair has been recognized as an important treatment option for rotator cuff tears. Sufficient visualization is of paramount importance for the arthroscopic repair to be efficiently and effectively performed. Intra-articular bleeding is one of the main factors which compromises the visual clarity in arthroscopic procedures. [1,2] Therefore, several hemostatic techniques, including hypotensive anesthesia, electrocauterization, and use of pressure-or flow-controlled pumps, are utilized to prevent intraoperative bleeding and to obtain sufficient visualization during the arthroscopic surgical procedures. [3][4][5] Recently, a number of clinical trials have supported the use of irrigation fluid with Objectives: This study aims to investigate whether there was a difference between epinephrine (EPN) and tranexamic acid (TXA) in providing visual clarity during arthroscopic rotator cuff tear repair.Patients and methods: This double-blind, prospective, randomized-controlled clinical study included a total of 90 patients (42 males, 48 females; mean age: 55.6±8.3 years; range, 18 to 69 years) in whom either EPN (EPN group, n=47) or TXA-diluted irrigation solutions (TXA group, n=43) were used during rotator cuff tear arthroscopy between December 2017 and November 2019. Arthroscopy was performed using irrigation fluid containing 0.33 mg of EPN per 1 L of saline in the EPN group and 0.42 mg of TXA per 1 L of saline in the TXA group. All procedures were performed by two specialized shoulder surgeons. Visual clarity (primary endpoint) was rated by the operating surgeon using the Visual Analog Scale (VAS) in the immediate postoperative period. Secondary endpoints included total operating time (TOT), potential thrombotic or thromboembolic side effects, mean arterial pressure (MAP), and total amount of irrigation fluid used.Results: There was no significant difference in the surgeon rated-VAS scores between the groups. The mean VAS score was 7.6±1.62 (range, 4 to 10) in the EPN group and 7.1±1.74 (range, 3 to 10) in the TXA group (p=0.59). No cardiac, thrombotic, or thromboembolic complications were observed in any of the groups. Conclusion:Adding TXA to the irrigation fluid during the arthroscopic rotator cuff repair may provide similar visual quality to the EPN, as measured by VAS.

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Comparison of the efficacy of irrigation with epinephrine or tranexamic acid on visual clarity during arthroscopic rotator cuff repair: A double-blind, randomized-controlled study

Bayram

2021

Jt Dis Relat Surg

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“…Potential methods to decrease bleeding include hypotensive anesthesia, infusion pressure control, use of electrocautery and the addition of epinephrine to the infusion solution4, 5, which is the subject of the present study.…”

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confidence: 99%

Is it advantageous to add epinephrine to the arthroscopic infusion solution for the treatment of rotator cuff injury?

Veado

Teixeira²,

Castro

et al. 2013

Revista Brasileira de Ortopedia (English Edition)

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Objective: To evaluate the use of epinephrine in arthroscopic infusion serum as a measure to improve the quality of surgical viewing during procedures for treating rotator cuff tears. Methods: This was a prospective randomized double-blind comparative study in which 49 arthroscopic repair procedures on rotator cuff tears were evaluated. Patients presenting ASA I and II surgical risk were included. The patients were placed into two groups: the first with epinephrine (1 mg/L) in the infusion serum and the second with pure physiological solution. A single surgeon was responsible for the procedures, without knowledge of the medication usage. The surgeon rated his quality of viewing during the operation, on an increasing scale from 0 to 10. Interscalene block or suprascapular nerve block was chosen randomly and used in association with general anesthesia. The anesthetist issued final report relating to possible intercurrences. Results: The group with epinephrine received an average score of 9.29 and the group without epinephrine received an average score of 7.16. The difference was statistically significant (p < 0.05). There was no important clinical alteration relating to use of this drug. Conclusion: As well as being safe, addition of epinephrine at a concentration of 1 mg/L to the infusion serum was shown to be effective for improving the visual field during arthroscopy to repair rotator cuff injuries.

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“…Complex reconstructive procedures such as arthroscopic repair of large rotator cuff tears are often lengthy and technically challenging operations working predominantly in the subacromial space, which can take longer than the same operation performed through a 'mini-open' incision. Knowledge of the vascular anatomy and various techniques to limit blood loss and improve visibility have been described [5][6][7][8][9]. These include anaesthetic considerations such as the effects of nerve blocks and the intraoperative blood pressure, the use of arthroscopic pumps to control irrigation fluid pressure and radiofrequency devices for haemostasis.…”

Section: Introductionmentioning

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Blood Loss in Arthroscopic Shoulder Surgery: Is it Clinically Important?

et al. 2013

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Background The blood loss associated with arthroscopic surgery has generally been considered to be minimal and not clinically relevant. However, there are currently no data available in the published literature to support this assumption. Methods The present prospective study used spectrophotometry of collected irrigation fluid to measure the blood loss associated with a variety of arthroscopic shoulder procedures conducted in 20 patients. Results Measured blood loss ranged from 1.22 mL to 36.45 mL. This confirmed that, even in lengthy arthroscopic procedures without a tourniquet, blood loss is minimal. Conclusions The results obtained in the present study confirm the presumed advantage of arthroscopic surgery in terms of blood loss, and also confirm that the full range of arthroscopic shoulder surgery can be safely performed, from a haemodynamic perspective, as day case procedures.

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Turbulence control as a factor in improving visualization during subacromial shoulder arthroscopy

Cited by 50 publications

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Comparison of the efficacy of irrigation with epinephrine or tranexamic acid on visual clarity during arthroscopic rotator cuff repair: A double-blind, randomized-controlled study

Comparison of the efficacy of irrigation with epinephrine or tranexamic acid on visual clarity during arthroscopic rotator cuff repair: A double-blind, randomized-controlled study

Is it advantageous to add epinephrine to the arthroscopic infusion solution for the treatment of rotator cuff injury?

Blood Loss in Arthroscopic Shoulder Surgery: Is it Clinically Important?

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