The Role of Hydrogen Peroxide In Surgery


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Hydrogen peroxide is one of those chemicals that has great potential with procedures that involve the human body. So how effective can it be in the king of all procedures -Surgery.

Surgery is one of the most important medicinal procedures. It requires the patient to be incised and vulnerable to all types of bacterial and microbial attacks.

Moreover, even after the surgery, the recovery process is a long and fragile one. Surgical wounds are known portals where microbes can freely enter and exit the body and cause all types of dangerous infections.

Hydrogen peroxide has a special ability to control infections. Moreover, it has shown some effect in the healing of wounds. So can it be used in post-surgical healing procedures? If yes then why?

So without further ado, let’s dive into the answers!

Hydrogen Peroxide is One of the Best Disinfectants We Have Discovered!

Hydrogen peroxide has been used for a couple of centuries now to clean and irrigate wounds. That’s because of how versatile it is in eliminating all types of microbes (regardless of being bacteria, virus, or fungi).

Secondly, hydrogen peroxide is safe for human use at lower concentrations. So there is a two-step benefit for using hydrogen peroxide.

But why is that so?


All of the versatility that hydrogen peroxide provides stems from its molecular structure. Hydrogen peroxide is a lot like water but so different. It has two oxygen atoms instead of one (as in water). And the second oxygen atom is loosely bound.

This makes hydrogen peroxide a fragile chemical. When it is exposed to light or air, it quickly dissociates into its constituent elements; hydrogen and oxygen. This oxygen is then able to react with other molecules in the vicinity and oxidize them.

All in all, this makes hydrogen peroxide an amazing oxidizing tool! And by controlling the setting of hydrogen peroxide exposure, we can turn it into an amazing bleaching, oxidizing or disinfecting agent.

Antimicrobial Effects

If properties of hydrogen peroxide were enlisted, its antimicrobial properties would be written at the top column.

Disinfection is the flagship quality of hydrogen peroxide. That’s because not only is hydrogen peroxide extremely proficient in killing microbes, it does it without any discrimination. What hydrogen peroxide does is fundamentally change the composition of cells.

Therefore, all types of microbes regardless of their kingdom can be treated using hydrogen peroxide. The oxygen from hydrogen peroxide reacts with the cell wall and DNA of the microbes and eliminates them.

This effect is most encouraged and relative to the field of medicine. The antimicrobial action of hydrogen peroxide makes it an amazing medicinal agent, especially during surgical procedures.

Not only can hydrogen peroxide perform local disinfection and irrigation of surgical wounds, but it can also be used in sterilizing equipment used in the surgery. More of it is discussed below!

Where Is It Used During Surgery?

Now that we know exactly what are some of the properties of hydrogen peroxide, we can move on to discussing the primary ways it is used in the field of surgery.

Most of the hydrogen-peroxide-related tasks are cleaning and disinfecting of gaping wounds to prevent future infections and whatnot. Some of them are discussed thoroughly below!

Wound Irrigation in Orthopaedic Surgery

Orthopedics refers to the treatment of bone and ligament-related ailments. Though bones are some of the most sturdy objects you can find inside the body, they can be prone to microbial attacks (especially bacterial attacks).

That’s because over the tough osteon (bone cells) lie that sensitive layer of the periosteum (literally meaning above-ostium). In addition, it contains a thin layer of nervous and secretory cells prone to infections (as seen in osteomyelitis).

The challenge doctors regularly face is that they need to prevent deep hardware infections in orthopedics. However,  fortunately for doctors (especially orthopedic surgeons), research indicates the antiseptic properties of hydrogen peroxide and its efficacy against bacteria.

Moreover, hydrogen peroxide has further shown increased effectiveness when it is irrigated (used in washing wounds) along with other washing solutions such as chlorhexidine and povidone-iodine.

The primary concern for surgeons is the cytotoxicity and embolic phenomenon after using hydrogen peroxide over the wounds. Given such factors, experts recommend using hydrogen peroxide for the wound irrigation of:

  • Partial Knee Replacement
  • Hemiarthroplasties
  • Native Joints

As hydrogen peroxide releases oxygen after breaking down, there is a risk for gas embolism associated with hydrogen peroxide use.

Gas embolism is when a particle of air (in this case, oxygen) lodges in the systemic vessels and blocks the blood supply to various parts.

There, gas embolisms can be potentially lethal if it gets stuck in the coronary (heart) or cerebral (brain) blood vessels. Some of the procedure which increases the hydrogen peroxide-related gas embolism in the body are:

  • Dural Compromise
  • Pressurizing Medullary Canals
  • Irrigating Smaller Closed Spaces

Furthermore, experts say hydrogen peroxide can be used alongside other wound irrigating solutions during total joint replacement.

Hemostatic Agent During Dermatologic Surgery

Dermatologic surgeries refer to the surgical procedures performed on the skin. Skin is the outermost layer of the body which is constantly exposed to hundreds of different bacteria and pathogens.

However, due to its tightly packed cells and roaming neutrophils (a type of WBC), it can defend against most pathogens that may enter the body.

When it comes to the use of hydrogen peroxide over the skin, it is not something to be surprised about. Hydrogen peroxide is used inside many different dermal ointments because of its amazing anti-inflammatory properties.

This means it can treat and decrease ectopic skin allergies (such as eczema) and inflammatory reactions such as acne. Moreover, hydrogen peroxide has been historically used to clean and irrigate superficial (present on the outer layer) skin wounds.

That is because not only is hydrogen peroxide an amazing antimicrobial agent, but it also promotes skin repair by stimulating collagen (a structural part of the skin) formation in the deeper layers of the dermis.

Similarly, a research article published points out how there is no clinical evidence of wound-healing impairment during the use of hydrogen peroxide for wound irrigation. As well as no clear evidence that suggests hydrogen peroxide leads to worse scar outcomes.

This article recommends hydrogen peroxide during dermatologic surgery because of its great hemostatic (blood clotting) properties.

Moreover, it negates genuine concerns of hydrogen peroxide use that it causes tissue necrosis and impaired wound healing. These concerns primarily stem from the oxidative burst phenomenon during the hydrogen peroxide mechanism.

By considering all of the points mentioned above, and that hydrogen peroxide is affordable, nonallergic, and can be obtained easily, it is underutilized, to say the least.

Dental Surgeries and Hydrogen Peroxide

The use of hydrogen peroxide orally is not a new procedure. There are a ton of uses of hydrogen peroxide inside your mouth, disinfecting being one of them.

You may recall the use of hydrogen peroxide for teeth whitening. However, the reactive oxygen that hydrogen peroxide liberates has amazing bleaching properties as well.

Using hydrogen peroxide along with your regular toothbrush may reduce the yellowish tint of teeth as well as kill off any germs that may be residing in your gums.

More recently, several scientists studied the effect of hydrogen peroxide mouthwash on COVID-19. This Cambridge University published article recommends the use of hydrogen peroxide after the onset of COVID-19 symptoms twice daily.

The concentration of hydrogen peroxide used in this procedure is, of course, 3%, intermixed partly with water.

All of these procedures stem from the fact that hydrogen peroxide is completely safe for mouth use. And more and more H2O2 based dentifrices are being marketed.

At lower concentrations and smaller dosages, hydrogen peroxide is able to kill germs and bacteria that reside in the mouth effectively, promoting the healing of wounds while maintaining safety protocols. Hydrogen peroxide has been used in the field of dentistry for 70 years.

All of the data above suggests that hydrogen peroxide is completely safe for oral use. Moreover, properties like wound healing promotion are striking for surgical procedures. Bacterial or any other microbial growth is a viable factor in post-surgery healing.

Open wounds provide an easy pathway for bacteria to cross the skin barrier and directly move in the blood. From that point on, microbes can cause all types of ailments. Therefore, advising hydrogen peroxide as a mouthwash after surgery for irrigation of wounds is a  procedure trusted by experts.

Hydrogen peroxide alone can eliminate all types of oral biota, as well as promote epithelial and collagen growth inside the wounds. This leads to a speedy recovery of the patient as well as preventing all types of oral infections. Hence, this article observed a quicker wound healing after a gingival surgery after administering hydrogen peroxide.

Hence, hydrogen peroxide is a trusted tool used in dentistry, granted that its concentration and dosage are monitored. Typically, hydrogen peroxide of 1%-3% shows the most potency while preventing oxidative damage.

Why is Hydrogen Peroxide Preferred Over Other Agents in Surgery?

A simple answer to that question would be hydrogen peroxide is the only organic and effective chemical.

Unlike other disinfecting agents, hydrogen peroxide does not liberate any harmful byproducts. This is because water and oxygen are two of the primary chemicals liberated by hydrogen peroxide, both of which are primary constituents of the human body.

Moreover, cells have receptors for hydrogen peroxide and oxygen, which lets them detect changes in the interstitium (fluid surrounding the cell) and react accordingly.

The second factor that makes hydrogen peroxide superior to all is how easily available it is. The brown bottle of 3% hydrogen peroxide solution is available in almost all homes that have a first aid kit in them. Not only that, but hydrogen peroxide is relatively cheap and easy to use.

The functionality of hydrogen peroxide is another great factor that encourages people to use it more than other disinfecting agents.

Using Hydrogen Peroxide to Sterilize Medical Equipment For Surgery

In addition to all of the surgical procedures we have mentioned above, hydrogen peroxide performs the most vital task of them all, sterilizing the surgical equipment.

It is extremely important for the patient that the tool used in incising or grabbing him is completely devoid of all the microbes and infectious agents. Unfortunately, Non-sterilization of surgical equipment is one of the most common causes of hospital-related deaths in third-world countries.

Hydrogen peroxide is an amazing tool used in the sterilization and cleaning of surgical equipment. Its disinfecting and oxidizing properties are second to none.

But, more than that, hydrogen peroxide provides hospitals with an alternative way of cleaning, low-temperature sterilization. This allows surgeons to sterilize those pieces of equipment that are heat or moisture-sensitive!

Can Hydrogen Peroxide Cause Any Complications During Surgery – Safety Factors

Now that we have gone through all of the basics of hydrogen peroxide and why it is used in various surgical procedures, we can move on to discuss some of the risk factors that this chemical poses.

Although hydrogen peroxide is a relatively safe chemical to use, mishandling it may cause unwanted side effects. Therefore, it is important to be careful during the procedure at all concentrations of hydrogen peroxide.

One of the complications hydrogen peroxides can lead to is an increased risk of gas embolism inside the body. This is particularly seen in wound irrigation during orthopedic surgery.

When the small or closed spaces are improperly irrigated using hydrogen peroxide, the atomic oxygen can coalesce to form particles of molecular oxygen gas. This gas can further evaporate from the site of injury to systemic blood vessels and lead to occlusions.

One of the foremost risks associated with hydrogen peroxide is its tendency to develop ROS species and cell death.

ROS are reactive oxygen species that can react with essential cell components like proteins and lipids, change their composition and induce cell death. However, the concentration of hydrogen peroxide that causes this is rather high.

Moreover, such phenomena have been negated in recent studies, especially those affiliated with low concentrations of hydrogen peroxide, such as 3%.

Another risk factor that hydrogen peroxide poses is in the form of mouthwash. At lower concentrations such as 1% or even 3%, hydrogen peroxide is completely safe to use.

However, if a solution of higher concentration or even abusing this concentration may lead to detrimental side-effects such as localized oral toxicity and irritant effects. Moreover, a person should be careful while using hydrogen peroxide as a mouthwash.

Ingesting a higher amount of hydrogen peroxide is dangerous at all concentrations and should be avoided.

The Bottom Line

Hydrogen peroxide has established itself as one of the best post-surgical agents. That’s because it can avoid all types of bacterial and microbial infections and helps the patients through a speedy recovery.

More than that, hydrogen peroxide is also used to sterilize surgical equipment, making it an even more important chemical in medicine and surgery.

So if you are someone who has gone into surgery or know someone who did, order a set of hydrogen peroxide bottles today!

Faizan Khan
Faizan Khan
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