DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174399

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

Amira Mohammed Badawy

Abstract


Background: Symptomatic Uterine leiomyomata may lead to many symptoms including abnormal uterine bleeding, mass pressure effects and infertility. Myomectomy is an option for conservative management, however, it is associated with some disadvantages, mainly increased intra-operative blood loss. Intra-myometrial vasopressin injection during myomectomy is an effective method to decrease the intraoperative bleeding due to its vasoconstrictor effect. Octreotide Acetate (OA) is another vasoconstrictor agent that have not been tested for gynaecologic indications. The current study was conducted to assess the efficacy of local injection of OA in reducing blood loss during conventional abdominal myomectomy, and to compare it with local instillation of vasopressin.

Methods: 60 cases with symptomatic leiomyomata were recruited and planned for abdominal myomectomy, they were divided randomly into 3 groups, 20 cases in each. Group I, where local vasopressin was used, group II, where OA was used, and group III (the control group), where no specific medication was used and only free Saline was injected locally.

Results: The overall results showed that OA group had significantly less operative time and less blood loss compared to control group. However, when compared to cases in group I, operative time and blood loss were significantly higher. Postoperative haemoglobin levels were significantly lower in group III compared to groups I (P = 0.039) and II (P = 0.044). Blood transfusion was indicated in 9 cases among group III, while only one case needed blood transfusion in group II, and no cases in group I.

Conclusions: The use of local intra-myometrial OA is an option for reducing blood loss during myomectomy, but still efficacy is less than local vasopressin. This may be attributed to the low concentrations used, and to the less potency of OA as a vasoconstrictor agent.


Keywords


Leiomyomata, Myomectomy, Octreotide Acetate, Uterine fibroids, Vasopressin

Full Text:

PDF

References


Sami Walid M, Heaton RL. The role of laparoscopic myomectomy in the management of uterine fibroids. Curr Opin Obstet Gynecol. 2011;23(4):273-7.

Downes E, Sikirica V, Gilabert-Estelles J, Bolge SC, Dodd SL, Maroulis C, et al. The burden of uterine fibroids in five European countries. Eur J Obstet Gynecol Reprod Biol. 2010;152(1):96-102.

Kitson SJ, Macphail S, Bulmer J. Is pregnancy safe after uterine artery embolisation? BJOG: An Internat J Obstetr Gynaecol. 2012;119(5):519-21.

Paul GP, Naik SA, Madhu KN, Thomas T. Complications of laparoscopic myomectomy: A single surgeon’s series of 1001 cases. Australian and New Zealand J Obstetr Gynaecol. 2010;50(4):385-90.

Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database of Systematic Reviews. 2014(8).

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.

Rodriguez-Ayala G, Moses D, Nimaroff M. The Use of Vasopressin to Reduce Blood Loss During Myomectomy. Journal of Minimally Invasive Gynecology. 2016;23(7, Supplement):S149.

Sinha M, Chiplonkar S. Anesthesia concerns in laparoscopic myomectomy. J Gynecol Endosc Surg. 2011;2(1):18-20.

Bildozola M. Efficacy of Octreotide and Sclerotherapy in the Treatment of Acute Variceal Bleeding in Cirrhotic Patients: A Prospective, Multicentric, and Randomized Clinical Trial. Scandinavian J Gastroenterol. 2000;35(4):419-25.

Dimech J, Feniuk W, Latimer RD, Humphrey PPA. Somatostatin-Induced Contraction of Human Isolated Saphenous Vein Involves sst2 Receptor-Mediated Activation of L-Type Calcium Channels. Journal of Cardiovascular Pharmacology. 1995;26(5):721-8.

Chatila R, Ferayorni L, Gupta T, Groszmann RJ. Local arterial vasoconstriction induced by octreotide in patients with cirrhosis. Hepatology. 2000;31(3):572-6.

World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310(20):2191-4.

Frederick J, Fletcher H, Simeon D, Mullings A, Hardie M. Intramyometrial vasopressin as a haemostatic agent during myomectomy. Br J Obstet Gynaecol. 1994;101(5):435-7.

Canseco-Lima JM, Hernandez-Denis A, Audifred-Salomon J. Vasopressin Myoma Infiltration During Hysteroscopic Myomectomy. J Minim Invasive Gynecol. 2015;22(6S):S123.

Zhao F, Jiao Y, Guo Z, Hou R, Wang M. Evaluation of loop ligation of larger myoma pseudocapsule combined with vasopressin on laparoscopic myomectomy. Fertil Steril. 2011;95(2):762-6.

Fletcher H, Frederick J, Hardie M, Simeon D. A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy. Obstet Gynecol. 1996;87(6):1014-8.

Cohen SL, Wang KC, Gargiulo AR, Srouji S, Goggins ER, Solnik J, et al. Vasopressin Administration During Laparoscopic Myomectomy: A Randomized Controlled Trial. Journal of Minimally Invasive Gynecology. 2015;22(6, Supplement):S39.

Deschamps A, Krishnamurthy S. Absence of pulse and blood pressure following vasopressin injection for myomectomy. Can J Anaesth. 2005;52(5):552-3.

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.