INTRAMYOMETRIAL VASOPRESSIN AS A HEMOSTATIC AGENT DURING MYOMECTOMY

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. Intervention Myomectomy was performed after the intramyometrial injection of either 20 units vasopressin diluted to 20 mi in normal saline or placebo (20 ml normal saline). Main outcome measures The efficacy of vasopressin was measured by comparing pre- and postoperative 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 1.7 g/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.