Effects of Cervical Vasopressin Versus N O Cervical Vasopress in on Blood Loss During Vaginal Hysterectomy

Abstract

BACKGROUND:Minimizing blood loss during surgery is important because of the associated morbidity. In addition intraoperative bleeding can obstruct the view of operative field and lead to complications, in particular dissection during vaginal hysterectomy can be hampered by blood loss, because the main blood supply is not ligated until after much of the dissection has been done. Several methods to control blood loss have been used including hydro dissection with saline as well as with the injection of vaso constrictors. AIMS: To compare blood loss, operative time, postoperative complication rates in patients undergoing vaginal hysterectomy who were randomly assigned to receive pre-operative intra cervical vasopressin or no intra cervical injection. SETTINGS

Vasopressin to Control Blood Loss during Hysterectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…The baseline characteristics of the included RCTs are summarized in Table 1. The RCTs were conducted during 2001-2021 and took place in the United States of America (n=4) [5][6][7]12], India (n=2) [1,9], and Iran (n=1) [10]. The majority of RCTs were vaginal hysterectomy (n=5) [1,5,7,9,12] with few abdominal hysterectomy (n=2) [6,10] and no laparoscopic hysterectomy.…”

“…The RCTs were conducted during 2001-2021 and took place in the United States of America (n=4) [5][6][7]12], India (n=2) [1,9], and Iran (n=1) [10]. The majority of RCTs were vaginal hysterectomy (n=5) [1,5,7,9,12] with few abdominal hysterectomy (n=2) [6,10] and no laparoscopic hysterectomy. The volume and dose of vasopressin were 10-40 ml and 3.6-10 units, respectively.…”

“…There was transient fall in pulse rate and BP in both groups which did not warrant medical intervention and was largely ascribed to neuroaxial anesthesia. Tripathi et al [1] highlighted a significant increase in mean BP at 5, 10, and 15 minutes post injection in disfavor of the vasopressin group, however, without any major cardiovascular sequelae.…”

“…Two RCTs [5,9] clearly stated surgeons were not blinded to treatment arms, and hence we scored the performance bias domain as high risk. On the other hand, two RCTs [1,7] did not provide enough details about blinding of the research personnel including surgeons, and hence we scored the performance bias domain as unclear risk. The lack of blinding of surgeons to drug administration is unlikely to significantly impact the validity of the outcomes.…”

“…Hysterectomy is the second most frequently performed gynecological operation after cesarean section [1]. It is indicated for a multiplicity of reasons, including benign and malignant conditions [2].…”