Intra-Articular adrenaline versus tourniquet in knee arthroscopy in a tertiary care center: a prospective cohort study

Arthroscopy has become one of the most commonly performed orthopaedic 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. Comparision 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