Tumescent infiltration in burn surgery: A systematic review
Michael Cheung1, Varun Harish1, 1Royal North Shore Hospital
Abstract
As a vasoconstrictor through activation of alpha adrenergic receptor, intraoperative subdermal adrenaline tumescent infiltration is a common practice to reduce blood loss and facilitate easier excision. There is a lack of standardisation in mode of delivery and concentration of adrenaline used. Here we conducted a systematic review with search terms “burns”, “adrenaline” or “epinephrine” and “infiltration” in Pubmed search engine. Nine publications from 1997 to 2023 returned, of which six articles were reviewed as they had documented the concentration of adrenaline used and mode of infiltration delivery.
1:500 000 and 1:1000 000 concentration (1mg adrenaline diluted into 500ml or 1000ml of saline) are commonly used in both paediatric and adult burn surgery. Though there were reported complications with pulmonary oedema and acute carpal tunnel syndrome, infiltration via a pump device has a superior result compared to a manual one in terms of surgical efficiency. Proper technique use of adrenaline infiltration avoiding systemic absorption is associated with minimal change in heart rate, rhythm and mean arterial pressure. Future studies should look at qualitative and quantitative effect on blood loss and cardiac monitoring with different concentration of adrenaline used in burn surgery.
Biography
Plastic Surgery and Burns Registrar (unaccredited) at Royal North Shore Hospital