Document Type : Original Article
Authors
- Fereshteh Rahimi 1, 2
- Roya Derakhshan 1, 3, 4
- Samaneh Rokhgireh 3
- Shahla Chaichian 1, 2, 5
- Banafsheh Nikfar 5
- Abolfazl Mehdizadehkashi 1, 2
1 Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
2 Iranian Scientific Society of Minimally Invasive Gynecology, Tehran, Iran
3 Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Tehran, Iran
4 Department of Artificial Intelligence, Smart University of Medical Sciences, Tehran, Iran
5 Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
Abstract
Background: Uterine leiomyoma is the most prevalent benign gynecologic tumor. This study compared the effectiveness and safety of vasopressin versus oxytocin intramyometrial injections in reducing blood loss during laparoscopic myomectomy.
Methods: In this randomized double-masked study, forty-six women were randomly assigned to receive either a sub-capsular intramyometrial injection of 10 IU oxytocin, diluted in 20 ml saline solution or a sub-capsular intramyometrial injection of 20 IU vasopressin at the time of uterine incision.
Results: The primary outcome measure was intraoperative bleeding, which was considerably lower in the group receiving vasopressin (97.73 82.53 vs 187.83 129.33, p-value = 0.008). No significant difference between the two groups was observed regarding hemoglobin reduction from baseline levels or the need for transfusion. During the operation, patients receiving vasopressin injections experienced a lower pulse rate than those receiving oxytocin injections (74.95 bpm vs 81.67 bpm, p-value = 0.02).
Conclusion: Vasopressin appears to be an effective option for bleeding reduction during laparoscopic myomectomy procedures; however, because of its cardiac effects, close uterine and cardiac monitoring and careful collaboration between the anaesthesiologist and the gynecologist are required. We can reserve oxytocin injections for cases where vasopressin is contraindicated due to cardiopulmonary problems.
Highlights
Abolfazl Mehdizadehkashi (Google Scholar) (PubMed)
Keywords
Main Subjects
- Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC women's health. 2012;12:1-11.
- Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100-7.
- Flake GP, Andersen J, Dixon D. Etiology and pathogenesis of uterine leiomyomas: a review. Environ Health Perspect. 2003;111(8):1037-54.
- Kitson SJ, Macphail S, Bulmer J. Is pregnancy safe after uterine artery embolisation? Bjog. 2012;119(5):519-21.
- Walid MS, Heaton RL. Laparoscopic myomectomy: an intent-to-treat study. Archives of gynecology and obstetrics. 2010;281:645-9.
- Dillon TF. Vasopressin as a hemostatic in gynecologic surgery. Am J Obstet Gynecol. 1959;78:1285-91.
- Akerlund M. Involvement of oxytocin and vasopressin in the pathophysiology of preterm labor and primary dysmenorrhea. Prog Brain Res. 2002;139:359-65.
- Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev. 2014;2014(8):Cd005355.
- Saha MM, Khushboo, Biswas SC, Alam H, Kamilya GS, Mukhopadhyay M, et al. Assessment of Blood Loss in Abdominal Myomectomy by Intramyometrial Vasopressin Administration Versus Conventional Tourniquet Application. J Clin Diagn Res. 2016;10(5):Qc10-3.
- Elgendy A, Ahmed A, Elhoussieny A, Gad H. Role of Vasopressin Injection Intramyometrial in Decreasing Blood Loss During Abdominal Myomectomy : A Randomized Controlled Trial. Evidence Based Women's Health Journal. 2021;11(1):83-9.
- Gimpl G, Fahrenholz F. The oxytocin receptor system: structure, function, and regulation. Physiol Rev. 2001;81(2):629-83.
- Sendemir A, Sendemir E, Kosmehl H, Jirikowski GF. Expression of sex hormone-binding globulin, oxytocin receptor, caveolin-1 and p21 in leiomyoma. Gynecol Endocrinol. 2008;24(2):105-12.
- Atashkhoei S, Fakhari S, Pourfathi H, Bilehjani E, Garabaghi PM, Asiaei A. Effect of oxytocin infusion on reducing the blood loss during abdominal myomectomy: a double-blind randomised controlled trial. Bjog. 2017;124(2):292-8.
- Nasief H, Hassan A, AlDardeir N, Khadawardi K, Alwazzan AB, Alothmani H, et al. Oxytocin infusion is a safe uterine bleeding controller alternative to blood transfusion in patients undergoing abdominal myomectomy. Anaesthesia, Pain & Intensive Care. 2024;28(1):5-9.
- Mehdizadehkashi A, Tahermanesh K, Rokhgireh S, Astaraei V, Najmi Z, Rakhshande M, et al. Uterine isthmus tourniquet during abdominal myomectomy: support or hazard? A randomized double-blind trial. Gynecologic and obstetric investigation. 2020;85(5):396-404.
- Albazee E, Sayad R, Elrashedy AA, Samy Z, Faraag E, Baradwan S, et al. Efficacy of oxytocics on reducing intraoperative blood loss during abdominal myomectomy: A systematic review and meta-analysis of randomized placebo-controlled trials. Journal of Gynecology Obstetrics and Human Reproduction. 2022;51(5):102358.
- Agostini A, Ronda I, Franchi F, Bretelle F, Roger V, Cravello L, et al. Oxytocin during myomectomy: a randomized study. Eur J Obstet Gynecol Reprod Biol. 2005;118(2):235-8.
- Frederick J, Fletcher H, Simeon D, Mullings A, Hardie M. Intramyometrial vasopressin as a haemostatic agent during myomectomy. BJOG: An International Journal of Obstetrics & Gynaecology. 1994;101(5):435-7.
- Assaf A. Adhesions after laparoscopic myomectomy: effect of the technique used. Gynaecological Endoscopy. 1999;8(4):225-9.
- Wang C-J, Lee C-L, Yuen L-T, Kay N, Han C-M, Soong Y-K. Oxytocin infusion in laparoscopic myomectomy may decrease operative blood loss. Journal of minimally invasive gynecology. 2007;14(2):184-8.
- Aslan Çetin B, Aydoğan Mathyk B, Köroğlu N, Soydar A, Demirayak G, Çift T. Oxytocin infusion reduces bleeding during abdominal myomectomies: a randomized controlled trial. Archives of Gynecology and Obstetrics. 2019;299(1):151-7.
- Soliman R, Yacoub A, Elbiaa AAM. Assessment of the perioperative effect of vasopressin in patients undergoing laparoscopic myomectomy: A double-blind randomised study. Indian J Anaesth. 2021;65(2):139-45.
- Hobo R, Netsu S, Koyasu Y, Tsutsumi O. Bradycardia and cardiac arrest caused by intramyometrial injection of vasopressin during a laparoscopically assisted myomectomy. Obstet Gynecol. 2009;113(2 Pt 2):484-6.
- Lee KH, Khan-Dawood FS, Dawood MY. Oxytocin receptor and its messenger ribonucleic acid in human leiomyoma and myometrium. Am J Obstet Gynecol. 1998;179(3 Pt 1):620-7.
- Otonkoski S, Sainio T, Komar G, Suomi V, Saunavaara J, Blanco Sequeiros R, et al. Oxytocin selectively reduces blood flow in uterine fibroids without an effect on myometrial blood flow: a dynamic contrast enhanced MRI evaluation. International Journal of Hyperthermia. 2020;37(1):1293-300.
- Weston GC, Cann L, Rogers PAW. Myometrial microvascular endothelial cells express oxytocin receptor. BJOG: an international journal of obstetrics and gynaecology. 2003;110(2):149-56.