The Effect of Topical Epinephrine Hydrochloride in Saline on Blood Loss Following Tangential Excision of Burn Wounds

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Abstract
Burn wounds that were excised tangentially in the first 21 days after the burn were dressed immediately following excision with either saline or epinephrine hydrochloride-saline compresses (30 mg in 1030 ml normal saline) that were then left for 30 minutes while skin was harvested and banked. Thereafter, saline compresses were applied to all patients' wounds and changed every 4 hours. Banked skin grafts were applied without the need of a second general anesthetic on the first postoperative day. In both groups of patients, blood loss exceeded 9 percent of the calculated blood volume for each 1 percent of the body surface excised (this included blood loss due to harvest of skin graft necessary to cover the excised wounds) when the excision was performed in the first 14 days after the burn. Addition of epinephrine did not reduce net blood loss. Premature ventricular contractions were not observed, although 2 of 29 patients had an elevation in pulse rate of 25 beats per minute or more. No factors were identified that would reduce the blood loss following early tangential burn excision. Before embarking on tangential excision in the early postburn period, one must be prepared to replace 10 percent of the circulating blood volume for each 1 percent of the body surface to be excised.

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