Epinephrine Infiltration and the Incidence of Bleeding Complications after Surgical Debridement of Pressure Ulcers with Negative Pressure Wound Therapy

Abstract

Background: For reducing intraoperative bleeding, epinephrine is commonly used as a vasoconstrictor with infiltration anesthesia. However, the effects of epinephrine on postoperative bleeding complications are still a matter of debate. Bleeding is a potential complication of negative-pressure wound therapy (NPWT), which is widely used in the post-debridement management of pressure ulcers. We hypothesized that the risk of post-debridement bleeding would be greater if negative pressure were applied postoperatively to pressure ulcers while bleeding conditions were masked by the vasoconstrictive effect of epinephrine. Methods: A 3-year retrospective chart review of 38 patients who received 204 surgical debridement and NPWT procedures was performed to evaluate the incidence of bleeding complications by type of local infiltration (i.e., no infiltration, lidocaine infiltration only, or infiltration of lidocaine mixed with epinephrine). Results: A total of 18 postoperative bleeding complications were observed, eight from the non-injection group and five from each of the lidocaine and lidocaine-epinephrine injection groups. Procedures with epinephrine infiltration had a 31.9% higher rate of bleeding complications than others, but the difference was without statistical significance. Conclusion: The use of epinephrine for infiltration led to a higher risk of bleeding complications when NPWT was applied after pressure sore debridement, but this trend did not reach statistical significance. A more detailed and extensive future study would help obtain more conclusive results.

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“…It's caused by two entities move in separate directions like the tailbone moving down when one slides on an elevated bed [8]. Moisture, such as sweat, causes maceration and breakdown of tissues hence triggering or complicating pressure sores [28].…”

“…Multiple research, including The National Pressure Ulcer Long-term Care Study, has proved that having a weak diet and frequent weight loss are the major risk factors for developing pressure sores [22]. Wounds in pressure | ulcers are chronic and immune to the normal iterative healing process, thanks to the presence of high bioburden [28]. In the pressure wound metabolic environment, there exists a dominant presence of Firmicutes, Proteobacteria, and Actinobacteria [13].…”

“…There are four types of debridement methods: enzymatic, mechanical, sharp, and autolytic [21]. The factors to consider when selecting a method include the patient's health condition, presence or absence of infection, the ulcer presentation, skill set of the practitioner, and patient's ability to endure the procedure [28].…”

“…And most importantly, will the new technology value the patient's decisions [9]? These are vital aspects that need to be addressed by physicians involved in the respective researches [28]. Patients and medical facilities will need to find common ground to manage the disease efficiently [18].…”