Fletcher, Horace M.; Frederick, Joseph; Hardie, Milton; Simeon, Donald T.
Author Affiliation, Ana.
Obstetrics, Gynaecology and Child Health
A randomized comparison of vasopressin and tourniquet as haemostatic agents during myomectomy.
Obstetrics and Gynecology
Date of Publication
To assess the comparative efficacy of perivascular vasopressin and tourniquet in minimizing bleeding and its sequelae at myomectomy, 52 women with symptomatic uterine leiomyomas scheduled for myomectomy were entered into a randomized trial, comparing vasopressin (26 patients) and tourniquet (26 patients) for haemostasis. The study was conducted between March 1994 and February 1995. Myomectomy was performed after either the perivascular injection of 20 U of vasopressin diluted to 20 mL with normal saline, or with the use of a Foley catheter tourniquet around both uterine vessels. The efficacy of each method was measured by comparing differences in pre- and post-operative haemoglobin levels, intra-operative blood pressure, measured blood loss, need for blood transfusion, evidence of post-operative febrile morbidity, complications, and length of hospital stay. Vasopressin resulted in less blood loss (mean 287.3 mL [standard deviation (SD) 195]) versus 512.7 mL [SD 400] for tourniquet [p=0.036]. Six of 26 patients in the tourniquet lost more than 1000 mL of blood, whereas all of the vasopressin subjects lost less than this amount (p=0.023). However, there were no significant differences between the two groups in the fall in haemoglobin level, number of blood transfusion given, intra-operative blood pressure, highest post-operative pulse and temperature, or other complications. Vasopressin, therefore, is more effective in preventing blood loss than use of the tourniquet during myomectomy.....