Evidence map›Paper›PMID 41329443›Full record

SynthesisEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2025

The effect of epinephrine-infused irrigation fluid on visual clarity in arthroscopic shoulder surgery: a meta-analysis.

Marc Boutros, Guy Awad, Akinkunmi Adio, Jad Lawand, Peter Boufadel, Mohammad Daher, Adam Z Khan, Brian W Hill, John G Horneff, Joseph A Abboud

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Marc BoutrosFaculty of Medicine, Saint Joseph University, Beirut, Lebanon. marceboutros@gmail.com.
Guy AwadFaculty of Medicine, Saint Joseph University, Beirut, Lebanon.
Akinkunmi AdioDepartment of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, USA.
Jad LawandThe University of Texas Medical Branch at Galveston, Galveston, USA.
Peter BoufadelDivision of Shoulder and Elbow Surgery, Rothman Orthopaedics, Philadelphia, USA.
Mohammad DaherDivision of Shoulder and Elbow Surgery, Rothman Orthopaedics, Philadelphia, USA.
Adam Z KhanDepartment of Orthopaedic Surgery, Southern California Permanente Medical Group, Panorama City, CA, USA.
Brian W HillPalm Beach Orthopaedic Institute, Palm Beach Gardens, FL, USA.
John G HorneffDepartment of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, USA.
Joseph A AbboudDivision of Shoulder and Elbow Surgery, Rothman Orthopaedics, Philadelphia, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn shoulder arthroscopy, visual clarity is essential for safe and efficient procedures, yet intraoperative bleeding often compromises the surgical field. Several randomized studies have demonstrated that adding epinephrine to irrigation fluid significantly reduces bleeding and enhances visual clarity. This meta-analysis synthesizes findings from multiple studies to critically evaluate the overall efficacy and safety of epinephrine in improving intraoperative visualization during arthroscopic shoulder surgery.

methodsA systematic literature search was conducted in PubMed, Embase, the Cochrane Library, and Google Scholar for studies published up to September 8, 2025. Eligible studies included randomized controlled trials and comparative observational studies evaluating the effect of epinephrine added to irrigation fluid during shoulder arthroscopy in adults. Primary outcomes included surgeon-rated visual clarity (scored on a 1-to-10 scale) and the incidence of increased pump pressure. Secondary outcomes included operative time, irrigation fluid volume used, and mean arterial pressure.

resultsSix studies met the inclusion criteria, including 422 adult patients undergoing arthroscopic shoulder surgery. Epinephrine use was associated with significantly improved surgeon-reported visual clarity, with a mean difference of 2.32 (95% CI 0.32-4.32; p = 0.02) compared to controls. The epinephrine group also had a significantly lower likelihood of requiring increased pump pressure (risk ratio = 0.39; 95% CI 0.27-0.57; p < 0.001). While trends toward reduced operative time (MD =  - 4.38 min; 95% CI: - 10.41 to 1.64; p = 0.15) and lower irrigation fluid volume (MD =  - 0.83 L; 95% CI: - 2.04 to 0.37; p = 0.18) were observed, these differences were not statistically significant. No significant differences in mean arterial pressure were found between groups (p > 0.05).

conclusionIn the studies reviewed, epinephrine in irrigation fluid during arthroscopic shoulder surgery significantly increases visual clarity. Based on surgical and patient-specific factors, this should be taken into consideration for arthroscopic shoulder procedures.

Indexed as

ArthroscopyBlood Loss, SurgicalEpinephrineShoulder JointVasoconstrictor AgentsHumansOperative TimeRandomized Controlled Trials as TopicTherapeutic IrrigationEpinephrineVasoconstrictor AgentsEpinephrineShoulder arthroscopyVisual clarity

Identifiers

PMID41329443

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.