Topic Adrenaline in post circumcision bleeding

Report By: Alannah Madden - Clinical Fellow ED
Search checked by Peter Hulme - Consultant
Institution: MRI
Date Submitted: 25th February 2020
Last Modified: 1st February 2021
Status: Orange (submitted and checked)

Three Part Question

In [patients with post-circumcion bleeding] does [topical adrenaline] [reduce bleeding]

Clinical Scenario

A 4 year old boy attended the paediatric emergency department following a circumcision for religious reasons earlier that day. He had ongoing bleeding from the surgical site.
Is there any evidence behind the use of topical adrenaline in the management of these patients.

Search Strategy

Using databases : CINAHL, EMBASE, Medline - last 10 years.
(topical adrenaline OR epinephrine).ti,ab
(post circumcision*
bleed*).ti,ab

# Database Search term Results
1 CINAHL (topical AND (adrenaline OR topical epinephrine)).ti,ab 103
2 CINAHL EPINEPHRINE/ 4600
3 CINAHL (1 OR 2) 4648
4 CINAHL (adrenaline OR epinephrine).ti,ab 4895
5 CINAHL (3 OR 4) 7043
6 CINAHL (post circumcision* bleed*).ti,ab 10
7 CINAHL CIRCUMCISION/ 1847
8 CINAHL (CIRCUMCIS*).ti,ab 1977
9 CINAHL (6 OR 7 OR 8) 2431
10 CINAHL (5 AND 9) 3
11 EMBASE (topical AND (adrenaline OR topical epinephrine)).ti,ab 385
12 EMBASE EPINEPHRINE/ 11985
13 EMBASE (adrenaline OR epinephrine).ti,ab 60783
14 EMBASE (11 OR 12 OR 13) 66227
15 EMBASE (post circumcision* bleed*).ti,ab 35
16 EMBASE CIRCUMCISION/ 8644
17 EMBASE (CIRCUMCIS*).ti,ab 8083
18 EMBASE (15 OR 16 OR 17) 10281
19 EMBASE (14 AND 18) 47
20 EMBASE 19 [DT 2009-2020] 20
21 Medline (topical AND (adrenaline OR topical epinephrine)).ti,ab 639
22 Medline EPINEPHRINE/ 54504
23 Medline (adrenaline OR epinephrine).ti,ab 51998
24 Medline (21 OR 22 OR 23) 76447
25 Medline (post circumcision* bleed*).ti,ab 47
26 Medline "CIRCUMCISION, FEMALE"/ 1304
27 Medline "CIRCUMCISION, MALE"/ 5079
28 Medline (CIRCUMCIS*).ti,ab 6369
29 Medline (25 OR 26 OR 27 OR 28) 8388
30 Medline (24 AND 29) 35
31 Medline 30 [DT 2009-2020] 8

Search Outcome

No evidence for the use of topical adrenaline in bleeding post circumcision

Comment(s)

There is no conclusive evidence currently published about the use of topical adrenaline in bleeding post circumcision.

Clinical Bottom Line

There is nothing published to date about the use of topical adrenaline in post circumcision bleeds, therefore it is not possible to conclude whether it is effective for this purpose.