Shoulder Draping with Adhesive Incise Drape Reduces Soft Tissue Swelling during Shoulder Arthroscopy - A Prospective Randomized Trial

Ofir Uri 1,2 Gil Laufer 1 Eyal Behrbalk 1 Nimrod Ron 1 Ram Yaron 2
1Orthopedic Surgery B, Hillel Yaffe Medical Center, Hadera, Israel
2Orthopedic Surgery, Assuta Hospital, Tel Aviv, Israel

Background: Fluid extravasation into the surrounding tissue is common in shoulder arthroscopy. It frequently leads to soft tissue swelling and edema around the shoulder which makes the arthroscopic procedure more difficult and may even lead to serious complications such as airway obstruction. Measures to reduce soft tissue swelling (e.g., low pump pressure, short arthroscopic time) should be encouraged. We hypothesized that preoperative draping of the shoulder with adhesive incise drape will reduce soft tissue swelling during shoulder arthroscopy.

Methods: Fifty patients undergoing arthroscopic rotator cuff repair were prospectively randomized into one of the study groups: (1) shoulder arthroscopy draping with the shoulder exposed, (2) shoulder arthroscopy draping with an adhesive incise drape (3M™ Ioban™ 2 Antimicrobial Incise Drape) tightened around the shoulder. Elastic bandage was placed around the arm to the axilla level in all cases. The circumference of the shoulder, arm, chest and neck, and the deltoid compartmental pressure were measured before and at the end of the procedure. The surgical time and the volume of irrigation fluid used were documented.

Results: Patients` age (range, 42-73 years), body-mass-index (range, 19-32 kg/m2), surgical time (range, 45-100 minutes) and the volume of fluids used (range, 6-15 liters) were similar for both groups. Postoperatively, shoulder circumference increased by 14±4% in the exposed shoulder group compared to 8±3% in the Ioban draped group (p<0.01). Neck, chest and arm circumference remained similar before and after the procedure in both groups. Deltoid compartmental pressure increased similarly in both groups from preoperative range of 6-16 mmHg to postoperative range of 16-38 mmHg.

Conclusion: Our findings suggest that preoperative draping of the shoulder with adhesive incise drape may reduce soft tissue swelling and offer an important clinical benefit during shoulder arthroscopy.