Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 6 West Sec, Chia-Pu Road, Putz City, Chiayi, 61363, Taiwan.
Center for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Int Orthop. 2018 Dec;42(12):2881-2889. doi: 10.1007/s00264-018-4021-9. Epub 2018 Jun 22.
To investigate whether epinephrine in irrigation fluid improves visual clarity in arthroscopic shoulder surgery.
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.
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.
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 I.
探讨关节镜肩关节手术中灌洗液中加入肾上腺素是否能提高手术视野清晰度。
我们对比较关节镜肩关节手术中应用肾上腺素与不应用肾上腺素患者手术结局的随机对照试验（RCT）进行了系统评价和荟萃分析。我们检索了 Cochrane 对照试验中心注册库、MEDLINE 和 Embase 以获取相关 RCT。我们使用 Cochrane 协作网的工具评估偏倚风险，并采用随机效应模型荟萃分析来合并数据。我们采用推荐、评估、制定与评价（GRADE）方法学评估检索证据总体质量。主要结局为手术视野清晰度。次要结局为手术时间、灌洗液用量、需要增加泵压的情况以及不良心血管事件。
本研究纳入了三项 RCT，共 238 名参与者（肾上腺素组 124 名，非肾上腺素组 114 名）。关节镜肩关节手术中灌洗液中使用肾上腺素可获得更好的手术视野清晰度（标准化均数差 1.01；95%置信区间 [CI] 0.63 至 1.39；p<0.0001），并减少需要增加泵压的情况（风险比 0.40；95%CI 0.25 至 0.64；p=0.0001），与非肾上腺素组相比。两组间手术时间（差值 -5.08；95%CI -14.46 至 4.31；p=0.29）和灌洗液用量（差值 -1.04；95%CI -2.38 至 0.39；p=0.12）无显著差异。纳入的试验均未记录到不良事件。
现有证据表明，在关节镜肩关节手术中使用肾上腺素可能提高可视化效果，且似乎没有明显的不利影响。
I 级。
