Effect of topical and subcutaneous epinephrine in combination with topicalthrombin in blood loss during immediate near-total burn wound excision in pediatric burned patients

Bleeding is a major concern during burn wound excision. To evaluate the eff icacy of epinephrine to control blood loss, a prospective cohort of 42 pedi atric patients were examined. Half of the patients received topical epineph rine to excised wounds and donor sites and subcutaneous epinephrine to scal p donor sites during total burn excision, while the other half did not. Bot h groups of patients received bovine topical thrombin sprayed at a concentr ation of 1000 U/ml. Mean blood loss in the epinephrine group was 1090 ml (r ange 20-4000), with a blood loss of 0.48 +/- 0.12 ml/cm(2) excised, while t he control group was 1271 ml (range 40-3750) and 0.51 +/-0.15 ml/cm(2). Dif ferences in preoperative and postoperative hematocrits were respectively -3 .4 +/- 7.8 and -4.6 +/- 7.5. The groups were not statistically different in this analysis. Subgroup analysis by age, burn size and time of burn to exc ision showed no differences. No complications or side effects of the use of the vasopressor solution occurred. In conclusion, no differences in blood loss were found between the groups. The routine use of local epinephrine du ring total wound excision in combination with topical thrombin in pediatric patients operated within 24 h after the admission may not be necessary. Th e effect of topical thrombin on blood loss should be analyzed separately. ( C) 1999 Elsevier Science Ltd and ISBI. All rights reserved.