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Epinephrine in irrigation fluid for visual clarity in arthroscopic shoulder surgery: a systematic review and meta-analysis

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Abstract

Purpose

To investigate whether epinephrine in irrigation fluid improves visual clarity in arthroscopic shoulder surgery.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared the surgical outcomes of patients who did and did not receive epinephrine during arthroscopic shoulder surgery. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for relevant RCTs. We used the Cochrane Collaboration’s tool to assess the risk of bias and adopted random-effects model meta-analysis to combine data. We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology to evaluate the overall quality of the body of the retrieved evidence. The primary outcome was visual clarity. The secondary outcomes were operative time, amount of irrigation fluid, the need for increased pump pressure, and adverse cardiovascular events.

Results

This study included three RCTs with a total of 238 participants (124 in the epinephrine group and 114 in the non-epinephrine group). The use of epinephrine in irrigation fluid for shoulder arthroscopy achieved better visual clarity (standardized mean difference, 1.01; 95% confidence interval [CI] 0.63 to 1.39; p < 0.0001) and less need for increased pump pressure (risk ratio, 0.40; 95% CI 0.25 to 0.64; p = 0.0001) compared to the non-epinephrine group. No significant differences were noted in operative time (mean difference − 5.08; 95% CI − 14.46 to 4.31; p = 0.29) and amount of irrigation fluid (mean difference − 1.04; 95% CI − 2.38 to 0.39; p = 0.12) between the two groups. No adverse events were recorded in any of the included trials.

Conclusions

The current evidence shows that the use of epinephrine in arthroscopic shoulder surgery may improve visualization and does not appear to have any major disadvantages.

Level of evidence

Level I

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Acknowledgements

The authors thank Ms. Yu-Shiun Tsai for her help in searching the databases and obtaining the full text of the trials.

Author information

Author notes

  1. Wei-Hsiu Hsu and Ching-Chi Chi contributed equally to this work.

Authors and Affiliations

  1. Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 6 West Sec, Chia-Pu Road, Putz City, Chiayi, 61363, Taiwan

    Liang-Tseng Kuo, Chi-Lung Chen, Pei-An Yu & Wei-Hsiu Hsu

  2. Center for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Liang-Tseng Kuo & Ching-Chi Chi

  3. College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Wei-Hsiu Hsu & Ching-Chi Chi

  4. Department of Dermatology, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Linkou, Taoyuan, 33305, Taiwan

    Ching-Chi Chi

  5. Department of Orthopaedic Surgery, College of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea

    Jae-Chul Yoo

Authors
  1. Liang-Tseng Kuo
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  2. Chi-Lung Chen
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  4. Wei-Hsiu Hsu
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Contributions

Author A was responsible for the study concept and design and drafting of the manuscript. Author A and Author B were responsible for the trial selection and appraisal of methodological quality. Author A and Author C participated in acquisition, analysis, and interpretation of data. Author E provided consultation of statistics and methodology. Author F provided consultation of clinical and reviewed the manuscript. Author D and Author E were in charge of the study concept and design, supervised the study, and critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Wei-Hsiu Hsu or Ching-Chi Chi.

Ethics declarations

Conflict of interest

Liang-Tseng Kuo, Chi-Lung Chen, Pei-An Yu, Wei-Hsiu Hsu, Ching-Chi Chi, and Jae-Chul Yoo declare that they have no conflict of interest.

Ethical approval

No ethical approval is needed for our systematic review and meta-analysis.

Informed consent

No identifying information about individual participants was shown in this systematic reivew, and thus inform consent was not needed.

Electronic supplementary material

Table S1

GRADE Recommendation of Outcomes (DOCX 16 kb)

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Kuo, LT., Chen, CL., Yu, PA. et al. Epinephrine in irrigation fluid for visual clarity in arthroscopic shoulder surgery: a systematic review and meta-analysis. International Orthopaedics (SICOT) 42, 2881–2889 (2018). https://doi.org/10.1007/s00264-018-4021-9

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  • DOI: https://doi.org/10.1007/s00264-018-4021-9

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