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Anesth Essays Res. 2019 Jul-Sep;13(3):405-410. doi: 10.4103/aer.AER_89_19.

High-volume, Multilevel Local Anesthetics-Epinephrine Infiltration in Kyphoscoliosis Surgery: Blood Conservation.

Author information

Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Department of Orthopedic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Department of Neurosurgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.



Scoliosis surgery is usually associated with severe bleeding. Various systemic strategies for blood conservation were applied, while the local techniques get less attention. The preemptive use of sufficient volume for proper tissue infiltration at two levels was applied. The local epinephrine may control bleeding without reliance upon deliberate hypotension, permitting a higher tissue perfusion.

Materials and Methods:

This prospective study included 46 patients scheduled for posterior spinal fusion for scoliosis correction. Patients were randomized into two groups. group I received a cocktail of high volume (100 ml/each 10 cm of wound length) of local anesthetics and epinephrine tumescent infiltration at the subcutaneous (SC) followed by intramuscular level bilaterally. Group C received saline infiltration in the same technique. Statistically, data were analyzed according to its distribution using the t-test, Mann-Whitney, and Chi-square tests as appropriate.


There was a significant reduction in blood loss (38%), reduced blood and fluid transfusion (36% and 23%), and reduced operative time (23%), with higher surgeon satisfaction. The surgical field visibility (Fromme's scale) was much better during SC and muscular dissection in Group I, while it was fair during the bony work. The satisfactory field in spite of higher mean blood pressure in Group I greatly omitted the reliance upon deliberate hypotension.


The high-volume multilevel infiltration of epinephrine cocktail can provide a significant blood and operative time conservation in kyphoscoliosis surgery.


Blood conservation; blood loss; epinephrine; infiltration; scoliosis; tumescent

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