Intramyometrial vasopressin as a haemostatic agent during myomectomy

Abstract

Objective To assess the efficacy of intramyometrial vasopressin for minimising bleeding and its sequelae at myomectomy. Design A randomised placebo controlled trial. Setting University Hospital of the West Indies, Kingston, Jamaica. Subjects Twenty women with symptomatic uterine fibroids scheduled for myomectomy who satisfied entry criteria: 10 randomised to the vasopressin group and 10 to the control group. Intervention Myomectomy was performed after the intramyometrial injection of either 20 units vasopressin diluted to 20 ml in normal saline or placebo (20 ml normal saline). Main outcome measures The efficacy of vasopressin was measured by comparing pre‐ and post‐operative haemoglobin levels and haematocrit, changes in intra‐operative pulse and blood pressure, measured blood loss, need for blood transfusion and post‐operative febrile morbidity in the treatment and control groups. Results The use of vasopressin resulted in median blood loss of 225 ml (range 150–400 ml) compared with 675 ml (range 500–800 ml) in the placebo group (P < 0.001). The vasopressin group had a correspondingly lower fall in haemoglobin level (median 1.7g/dl vs 5.3 g/dl, P < 0.001) and haematocrit (median 5%vs 13%, P < 0.001) compared with the controls. Fifty percent of the placebo group had blood transfusions compared with none in the vasopressin group (P= 0.03). There were no significant differences between the groups in intra‐operative pulse and blood pressure or post‐operative white blood cell counts or temperature. Conclusion The results indicate that vasopressin is effective in preventing blood loss and reducing the need for blood transfusion during myomectomy.

A comparative study between the efficacy of local intra-myometrial injection of vasopressin and octreotide acetate, in reducing blood loss during myomectomy

“…Significant differences were seen regarding higher blood loss, greater change in haematocrit and higher rate of blood transfusions in the placebo group. 13 Similar findings were observed in the current study, as well many other trials. 14,15 When compared to local vasopressin injection, OA showed less efficacy in reducing blood loss (113±37.43 ml vs 279±148.28 ml).…”

Prospective randomised trial comparing gonadotrophin‐releasing hormone analogues with triple tourniquets at open myomectomy

“…7,13 One study compared intramyometrial vasopressin with mechanical occlusion of uterine vessels with a Foley catheter and found them to be equally effective in controlling surgical bleeding. 14 There is, however, a concern about potential pharmacological adverse effects associated with accidental intravasation of these drugs, including bradycardia, hypotension, pulmonary oedema, myocardial infarction and even cardiac arrest, to the extent that their use has been banned in some countries.…”

“…14 There is, however, a concern about potential pharmacological adverse effects associated with accidental intravasation of these drugs, including bradycardia, hypotension, pulmonary oedema, myocardial infarction and even cardiac arrest, to the extent that their use has been banned in some countries. [15][16][17] Another concern that we have with the use of any injectable vasoconstrictor is that the effect may either not cover the entire procedure necessitating repeat injections, or worse, as pointed out by the studies from Jamaica, 13,14 it will mask a bleeding vessel which will then become manifest postoperatively. The same may also apply to drugs which work by inducing myometrial contractions during surgery, such as misoprostol.…”

MRI Evaluation of the Uterine Structure after Myomectomy

“…The operating procedure was as follows. Before enucleating the leiomyoma, we injected vasopressin into the subserosa of the uterine incision [4] . Next we made a linear uterine incision with an electric scalpel on the most prominent part of the leiomyoma, taking care to make the incision as small as possible.…”