A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy

OBJECTIVE: To assess the comparative efficacy of perivascular vasopressin and tourniquet in minimizing bleeding and its sequelae at myomectomy. METHODS:between March 1994 and February 1995, 52 women with symptomatic uterine leiomyomas scheduled for myomectomy were entered into a randomized trial comparing vasopressin (26 patients) and tourniquet (26 patients) for hemostasis. 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 postoperative hemoglobin levels, intraoperative blood pressure, measured blood loss, need for blood transfusion, evidence of postoperative febrile morbidity, complications, and length of hospital stay. RESULTS: Vasopressin resulted in less blood loss (mean 287.3 mL [standard deviation (SD) 195] verus 512.7 mL [SD 400] for tourniquet [P = .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 = .023). However, there were no significant differences between the two groups in the fall in the hemoglobin level, number of blood transfusion given, intraoperative blood pressure, highest postoperative pulse and temperature, or other complications. CONCLUSION: Vasopressin prevents blood loss better than using the tourniquet durIng myomectomy.(AU)

Perivascular vasopressin versus tourniquet as haemostatic agents during myomectomy: a prospective randomised trial - abstract

This study sought to assess the efficacy of perivascular vasopressin compared to tourniquet in minimising bleeding and its sequelae at myomectomy. It was a prospective randomized trial carried out at the University Hospital of the West Indies, Kingston, Jamaica. Thirty-eight women with symptomatic uterine fibroids scheduled for myomectomy were recruited after satisfying eligibility criteria. There were 18 patients in the vasopressin group and 20 in the tourniquet group. Myomectomy was performed after the injection perivascularly of either 10 units vasopressin in 20 ml normal saline or with the use of a Foley catheter tourniquet around the uterine vessels. The efficacy of each method was measured by looking at differences in pre- and post-operative haemoglobin and haematocrit, changes in intraoperative pulse and blood pressure, measured blood loss, need for blood transfusion and evidence of post-operative febrile morbidity. Pre-operative variables were almost identical in both groups. The use of vasopressin resulted in less blood loss with a mean of 254 ml versus 401 ml for tourniquet (p = 0.09) approaching significance. This resulted in a similar fall in the haemoglobin mean, 1.7 versus 2.2 (p = 0.248). Of the 20 patients who received tourniquet 5 had to have blood transfusion compared to one of the 18 receiving vasopressin. There were no significant differences in highest post-operative pulse and temperature. The results suggest that vasopressin is as effective in preventing blood loss as the tourniquet and is probably better, reducing the need for transfusion during myomectomy (AU)

Low leg tourniquet

Low leg tourniquet at a site between the calf and the malleloi was routinely used during various elective surgical procedures on 106 non-ischaemic feet of seventy-four consecutive patients in the age group 2 - 65 years. The period of ischaemic lasted up to 75 minutes. Using appropriate arm-size pneumatic cuff and suitable arm inflation pressure, a completely bloodless field was achieved in 104 surgical procedures without any local distal complications. The technique of application of the low leg tourniquet is safe, satisfactory and avoids unnecessary ischaemia to a relatively large segment of the lower limb. Its routine use in all suitable cases of surgery on the foot merits further trial and is recommended (AU)