Stetson William B, Morgan Stephanie A, Polinsky Samuel, Chung Brian, Hung Nicole J
Stetson Lee Orthopedics and Sports Medicine, Burbank, California, U.S.A.
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A.
Arthrosc Tech. 2021 Jan 30;10(2):e411-e418. doi: 10.1016/j.eats.2020.10.025. eCollection 2021 Feb.
Arthroscopic surgery of the shoulder joint and the subacromial space requires adequate visualization to be effectively performed. Visual clarity is essential to perform a safe and successful arthroscopic procedure. The major determinants to provide visualization in the subacromial space and the glenohumeral joint include adequate inflow (dependent on the dimension of the inflow cannula), flow rate versus pressure, pump system versus gravity, the use of electrocautery and radiofrequency devices, blood pressure control and hypotensive anesthesia, and the type of irrigation solution used with or without the use of epinephrine. In 2012, the cost of a 30-mL (30-mg) vial of epinephrine was $6 (adrenalin/epinephrine injection, USP, Par Pharmaceuticals), and approximately 3 to 4 bottles would be used on average for a single shoulder arthroscopy. In 2019, the same 30-mL bottle of epinephrine cost $237, a nearly 40-fold increase. The purpose of our study is to describe the various factors and techniques that can be used to maintain visual clarity in shoulder arthroscopy without the use of epinephrine in the irrigation solution and the cost savings associated without the use of epinephrine.
肩关节和肩峰下间隙的关节镜手术需要有足够的视野才能有效进行。视觉清晰度对于安全、成功地实施关节镜手术至关重要。在肩峰下间隙和盂肱关节提供视野的主要决定因素包括充足的入流（取决于入流套管的尺寸）、流速与压力、泵系统与重力、电灼和射频设备的使用、血压控制和低血压麻醉，以及使用含或不含肾上腺素的灌洗溶液的类型。2012年，一瓶30毫升（30毫克）肾上腺素的价格为6美元（肾上腺素注射液，美国药典，帕尔制药公司），单次肩关节镜检查平均大约需要使用3至4瓶。2019年，同样30毫升一瓶的肾上腺素价格为237美元，几乎上涨了40倍。我们研究的目的是描述在灌洗溶液中不使用肾上腺素的情况下，可用于在肩关节镜检查中保持视觉清晰度的各种因素和技术，以及不使用肾上腺素所带来的成本节约。
