Table 2 Articles included in the review analyzing the use of epinephrine in periarticular infiltrations
From: Periarticular infiltration used in total joint replacements: an update and review article
Name | Type of study | Number of patients | Groups and findings | Administration | Findings | Complications |
|---|---|---|---|---|---|---|
Kong et al. [18] | RCT | 116 patients (134 knees) | 2 randomly allocated groups: Epinephrine mixed in or not | 0.3Â mL epinephrine (1:1000) mixed with ropivacaine and triamcinolone | No significant differences in postoperative numerical pain scale, dose of fentanyl using PCA or active range of motion | No complications |
Chareancholvanich et al. [19] | RCT | 80 TKA patients | 2 randomly allocated groups: epinephrine, control | 20 mL 0.5% bupivacaine, 30 mg ketorolac, ± 0.6 mg epinephrine (1:1000), diluted with NS for a total volume 100 mL | Statistically significant reduction in visual analog pain scores at 6 and and 12 h with reduced morphine hours. Magnitude did not reach MCID for TKA | None |
Liu et al. [20] | RCT | 195 THA patients | 3 groups: intravenous low dose epinephrine + TXA, topical diluted epinephrine plus TXA, TXA alone |  | Combined LDEPI and TXA was more effective in reducing periop blood loss and alleviating inflammatory response than TXA alone | No complications |
Teng et al. [21] | Metanalysis | 5 studies in THA/TKA | 335 in epinephrine group, 311 in control group | intra-articular, local, lavage or IV | Epinephrine significantly reduced postop bleeding volume in TJA without increasing DVT risk. No reduction in intraop blood loss, postop hemoglobin loss and transfusion rate | No complications |
Villatte et al. [22] | RCT | 150 THA patient | Group 1: ropivacaine with epinephrine, Group 2: no infiltration | Â | LIA patients have less pain using VAS scores, no differences in analgesic consumption, recovery or bleeding | No complications |
Gao et al. [23] | RCT | 100 THA patients | Group 1: 3 g intra-articular TXA + 0.25 mg diluted epi. Group 2: 3 g topical TXA alone |  | Topical TXA plus epinephrine reduced total blood loss, hidden blood loss and transfusion | No complications |
Mikjunovikj-Derebanova et al. [24] | RCT | 63 pediatric patients undergoing surgical treatment of upper limb fractures | Group 1: Lidocaine 2%, bupivacaine 0.25% to a total volume of 0.5Â ml/kg Group 2: 25 mcg epinephrine in 2Â mL of 2% solution of lidocaine and 0.25% bupivacaine to a total volume of 0.5Â ml/kg Group 3: 2% lidocaine 2Â mL and 0.25% bupivacaine with 2Â mg dexamethasone to a total volume on 0.5Â ml/kg | Supraclavicular or interscalene block with one of three cocktails | Epinephrine prolonged motor and sensory effects for about 30Â min on average. Dexamethasone compared to both groups prolonged both sensory and motor effects in a statistically significant manner | None |