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Dilute versus concentrated vasopressin administration during laparoscopic myomectomy: a randomised controlled trial
Author(s) -
Cohen SL,
Senapati S,
Gargiulo AR,
Srouji SS,
Tu FF,
Solnik J,
Hur HC,
Vitonis A,
Jonsdottir GM,
Wang KC,
Einarsson JI
Publication year - 2017
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14179
Subject(s) - medicine , vasopressin , blood loss , tolerability , adverse effect , saline , randomized controlled trial , anesthesia , population , demographics , dosing , clinical trial , urology , surgery , demography , environmental health , sociology
Objective To determine if higher‐volume, fixed‐dose administration of vasopressin further reduces blood loss at the time of minimally invasive myomectomy. Design Randomised multicentre clinical trial. Setting Tertiary‐care academic centres in the USA . Population Women undergoing conventional laparoscopic or robot‐assisted laparoscopic myomectomy. Methods All participants received the same 10‐unit (U) dose of vasopressin, but were randomly assigned to one of two groups: (i) received 200 ml of diluted vasopressin solution (20 U in 400 ml normal saline), and (ii) received 30 ml of concentrated vasopressin solution (20 U in 60 ml normal saline). Main outcome measures The primary study outcome was estimated blood loss; the study was powered to detect a 100‐ml difference. Results A total of 152 women were randomised; 76 patients in each group. Baseline demographics were similar between groups. The primary outcome of intraoperative blood loss was not significantly different, as measured by three parameters: surgeon estimate (mean estimated blood loss 178 ± 265 ml and 198 ± 232 ml, dilute and concentrated groups respectively, P = 0.65), suction canister‐calculated blood loss, or change in haematocrit levels. There were no vasopressin‐related adverse events. Conclusion Both dilute and concentrated vasopressin solutions that use the same drug dosing demonstrate comparable safety and tolerability when administered for minimally invasive myomectomy; however, higher volume administration of vasopressin does not reduce blood loss. Tweetable abstract This randomised trial failed to show benefit of high‐volume dilute vasopression.