Effect of Diluted Vasopressin vs Saline on Intraoperative Blood Loss during Vaginal Hysterectomy- A Randomised Controlled Trial

Abstract

Introduction: Vasopressin has been used to control blood loss in gynaecological surgeries such as in myomectomy, abdominal hysterectomy etc. Only few studies have demonstrated its efficacy in Vaginal Hysterectomy (VH) in reducing intraoperative blood loss. VH is frequently performed gynaecological surgery in safe lower dose of vasopressin. There is no consensus on dose of infiltration. Aim: To compare submucosal vasopressin vs saline infiltration during VH and assess surgical parameters i.e., intraoperative blood loss, postinfiltration vitals, ease of dissection, use of electrocautery, need of blood transfusion and complications. Materials and Methods: This randomised controlled trial was done in department of Obstetrics and Gynaecology in collaboration with Department of Anaesthesia from November 2017 to April 2019. Low risk women aged <65 years with Pelvic Organ Prolapse Quantification-Stage (POP-Q stage) III/IV prolapse were recruited from Outpatient Department (OPD). They were randomised into two groups. Group I (n=35) patients received submucosal infiltration with diluted vasopressin (40mL vasopressin of 0.1U/mL, total 4U), prior to the incision. Group II (n=35) patients received 40cc of normal saline. Vitals were checked at one and five minutes postinfiltration. All the qualitative parameters were compared between the two groups by chi-square test and quantitative parameters by unpaired t-test. Inter and intragroup comparison was done by Repetitive Measure ANOVA followed by Tukey’s test. For the parameters, which did not follow the Gaussian distribution, were compared by non-parametric Mann-Whitney test between the two groups. A p-value <0.05 was considered as significant. All the data analysis was carried out in Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The mean estimated blood loss from incision till creation of flaps was half in vasopressin group as compared to saline group (21.33 mL vs 49.67 mL, p-value=0.001). Vasopressin group had less use of electrocautery, whereas ease of dissection was more in saline group. There was no significant difference in duration of surgery till flap creation and need of blood transfusion. There was fall in pulse rate and Blood Pressure (BP) in both groups which did not require medical intervention and was likely due to neuraxial anaesthesia. Conclusion: Vasopressin appears to be safe and effective in VH at infiltration dose of four units in dilution. However further studies on larger sample size are recommended to gather more evidence in this regard.