C J Ascher-Walsh1, T Capes, J Smith, A Michels. 1. Department of Ob/Gyn and Reproductive Science, Mount Sinai School of Medicine, New York, New York 10029, USA. Charles.Ascher-Walsh@mssm.edu
Abstract
OBJECTIVE: To compare blood loss, operative time, postoperative pain medication requirements, and complication rates in patients undergoing vaginal hysterectomy who were randomly assigned to receive preoperative intracervical vasopressin or no intracervical injection. METHODS:Fifty-eight women undergoing vaginal hysterectomy were randomly allocated to receive either eight units of vasopressin intracervically or nothing preoperative from January 2004 to January 2005. A researcher blinded to the study group determined blood loss. The surgeries were performed using uniform steps by senior residents under the direction of two attending surgeons. Multiple preoperative and postoperative values were evaluated, including time to specific points in surgery and use of postoperative pain medication. Independent sample t tests, Fisher exact test, and Pearson chi tests were used to analyze the data. RESULTS: The two groups were similar in terms of age, weight, parity, and ethnicity. There was also no difference in indication for surgery or estimated uterine size. The vasopressin group lost significantly less blood (145.3 mL compared with 266.4 mL control; P=.022). There was a significant difference in the increase in mean blood pressure at 5 minutes after injection (10.4 for the vasopressin group compared with. 2.5 for the control group, P=.043). There was no significant difference in immediate recovery room morphine requirements, but patient-controlled anesthesia usage was significantly higher in the vasopressin group. CONCLUSION: The preoperative injection of intracervical vasopressin leads to decreased blood loss during vaginal hysterectomy. There was, however, a significant increase in postoperative morphine use in patients receiving vasopressin. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00799292 LEVEL OF EVIDENCE: I.
RCT Entities:
OBJECTIVE: To compare blood loss, operative time, postoperative pain medication requirements, and complication rates in patients undergoing vaginal hysterectomy who were randomly assigned to receive preoperative intracervical vasopressin or no intracervical injection. METHODS: Fifty-eight women undergoing vaginal hysterectomy were randomly allocated to receive either eight units of vasopressin intracervically or nothing preoperative from January 2004 to January 2005. A researcher blinded to the study group determined blood loss. The surgeries were performed using uniform steps by senior residents under the direction of two attending surgeons. Multiple preoperative and postoperative values were evaluated, including time to specific points in surgery and use of postoperative pain medication. Independent sample t tests, Fisher exact test, and Pearson chi tests were used to analyze the data. RESULTS: The two groups were similar in terms of age, weight, parity, and ethnicity. There was also no difference in indication for surgery or estimated uterine size. The vasopressin group lost significantly less blood (145.3 mL compared with 266.4 mL control; P=.022). There was a significant difference in the increase in mean blood pressure at 5 minutes after injection (10.4 for the vasopressin group compared with. 2.5 for the control group, P=.043). There was no significant difference in immediate recovery room morphine requirements, but patient-controlled anesthesia usage was significantly higher in the vasopressin group. CONCLUSION: The preoperative injection of intracervical vasopressin leads to decreased blood loss during vaginal hysterectomy. There was, however, a significant increase in postoperative morphine use in patients receiving vasopressin. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00799292 LEVEL OF EVIDENCE: I.
Authors: Rachel L Barr Grzesh; Alejandro D Treszezamsky; Suzanne S Fenske; Lauren G Rascoff; Erin L Moshier; Charles Ascher-Walsh Journal: JSLS Date: 2018 Jul-Sep Impact factor: 2.172