Low-dose epinephrine does not reduce blood loss during TURP but lowers hypotension risk

In patients undergoing transurethral resection of prostate (TURP), treatment with low-dose epinephrine falls short of reducing blood loss during the operation but appears to minimize the incidence of hypotension, as reported in a study.

The study included 36 patients scheduled to undergo bipolar TURP, none of whom had uncontrolled hypertension, cardiac disease, and on anticoagulants. These patients were randomly assigned to receive either intravenous epinephrine or normal saline at the same rate (0.05 μg/kg/min) throughout the procedure.

Intraoperative blood loss was the primary outcome. Secondary outcomes included incidence of intraoperative hypotension (due to spinal anaesthesia), resection time, indwelling catheter time, and length of hospitalization.

Demographic and baseline clinical profiles did not significantly differ between the two treatment groups. The median prostate size was 41 g overall.

Low-dose epinephrine had no significant effect on the primary outcome, with the mean intraoperative blood loss being numerically lower than the control group (75.14 vs 67.91 mL; p=0.086).

However, intraoperative hypotension occurred with significantly lower frequency in the low-dose epinephrine group than in the control group (8.3 percent vs 33.3 percent; p=0.01).

There were no significant between-group differences seen in other secondary outcomes, namely resection time (p=0.97), mean indwelling catheter time (p=0.94), postoperative complications (p=0.73), and length of hospitalization (p=0.87).

The findings showed that low-dose epinephrine may help prevent hypotension during TURP, an outcome that complicates spinal anaesthesia especially in older patients.