Intra-Articular Adrenaline Versus Tourniquet in Knee Arthroscopy: A Cohort Study

Kathmandu University School of Medical Sciences169 enrolled

Overview

Arthroscopy has become one of the most commonly performed orthopedic surgeries in the world due to it being a minimally invasive technique. Clear visualization is crucial for both safe and efficient arthroscopic procedures. Pneumatic tourniquet has been widely used in knee arthroscopic surgeries to obtain bloodless surgical field, improve visualization, and thereby surgical time. However, complications from tourniquet use are not uncommon, particularly in patients whose procedure takes longer than 60 minutes. Using a tourniquet could increase problems, such as electromyographic alterations, nerve compressions, arterial occlusions, delayed muscle recovery, and muscle weakness. Intra-articular adrenaline injection creates a bloodless field by reducing local perfusion through its vasoconstrictive properties, mimicking the effect of a tourniquet. It appeared to be a potentially effective and safe option. Therefore, this study aimed to evaluate intra-articular adrenaline infiltration as an alternative for achieving a bloodless field without tourniquet-related side effects, in terms of clinical efficacy, operative duration and safety. We would compare intra operative visibility and safety of intra articular adrenaline (1:200,000) injections with use of a tourniquet in arthroscopic knee surgeries. Comparison is made between one group that received standard tourniquet application and another group that received intra articular adrenaline injection. Then the intraoperative visibility in these two groups is compared using tools like surgeon visual analogue score and amount of irrigation fluid required. The effectiveness and safety of the method used is compared using appropriate statistical tools. Null Hypothesis: There is no difference in intraoperative visibility and safety during knee arthroscopic surgeries with standard tourniquet application versus intraarticular adrenaline injection. H0: outcome in Adrenaline group =\< outcome in Tourniquet group Alternative Hypothesis: Intra articular adrenaline injection is better than tourniquet use in arthroscopic knee surgeries with respect to operative field visibility and safety. H1: outcome in Adrenaline group \> or (not less than) outcome in Tourniquet group

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Interventions

TourniquetPROCEDURE

The tourniquet in all groups are applied over proximal thigh with well-padded cotton and inflated (only in Group A - Tourniquet Administration Group's) to 100 -150mm of Hg higher than systolic pressure of the patient. Other group - Group B, have no inflation of tourniquet, but only applied.

AdrenalinePROCEDURE

Both groups will be injected at portal and intra-articular with an injection solution (Group A will be infiltrated with 60 ml of normal saline only and Group B will be injected with 60 ml of 1:200,000 adrenaline diluted in 100 ml of normal saline)

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: \- Patients who are skeletally matured (18 year and above) undergoing knee arthroscopic surgeries. The surgeries included are: * Anterior Cruciate Ligament reconstruction * Anterior Cruciate Ligament repair * Anterior Cruciate Ligament decompression * Meniscus repair surgeries * Meniscus resection surgeries - Patients who provide consent for the study Exclusion Criteria: * The patient with following procedures are excluded: * Posterior Cruciate Ligament (PCL) surgeries * Multi-ligament surgeries * Osteochondral or intra articular fractures * Patients under 18 years of age * Patients who do not provide consent

Outcomes

Primary Outcomes

Intraoperative Visibility Assessed by Surgeon Visual Analogue Scale (VAS)

Intraoperative visibility during arthroscopic knee surgery will be assessed by the operating surgeon using a 10-point Visual Analogue Scale (VAS), ranging from 0 to 10, where 0 indicates excellent visibility and 10 indicates extremely poor visibility. Lower scores indicate better operative visibility.

Time frame: 1.5 years

Intraoperative Irrigation Fluid Requirement

The total volume of irrigation fluid used during arthroscopic knee surgery will be recorded in milliliters (mL). Lower irrigation fluid requirement indicates better operative visibility and efficiency.