Review of epinephrine solution use in 400 consecutive cases of burn reconstruction. Are infusion pumps safe?

Infiltration of diluted epinephrine solutions is often used in reconstructive surgery to produce local vasoconstriction and minimize bleeding. A total of 400 burn reconstruction procedures were performed with the aid of epinephrine solution between July 2008 and July 2011. We used to consider this practice very safe, but after encountering several complications, we decided to perform a retrospective review to look at all complications in detail and identify opportunities to improve safety. We encountered nine complications including one case of flash pulmonary edema and one patient with acute carpal tunnel syndrome. All severe complications were seen when the epinephrine solution was infiltrated with the aid of an electric infusion pump. Infusion pumps do not allow for reliable control of the amount of infiltration of epinephrine solutions. We conclude that infusion pumps may unnecessarily increase the risk for complications. This has resulted in a change in our practice. We now use infusion pumps only in selected cases.