A Randomized Clinical Trial Comparing the Effect of Rectal Misoprostol with Intramyometrial Vasopressin on Blood Loss during Laparoscopic Myomectomy.

OBJECTIVES

This study aimed to compare the efficacy of rectal misoprostol combined with intramyometrial normal saline versus intramyometrial vasopressin in reducing blood loss during laparoscopic myomectomy.

MATERIALS AND

METHODS

This was a randomized, double blind, controlled trial (CTRI/2023/05/053204). A total of 70 women scheduled for laparoscopic myomectomy were enrolled and equally randomized into two groups: Group I (received rectal misoprostol 400 µg 1 h before surgery) and Group II (received intramyometrial vasopressin 20 IU in 200 ml NS dilution). Final analysis was conducted on 64 patients due to missing data (4 in Group I and 2 in Group II). The primary outcome was intraoperative blood loss.

RESULTS

Baseline clinical characteristics were similar between the groups. Intraoperative blood loss was significantly higher in the misoprostol Group I compared to the vasopressin Group II (320.9 ± 131.9 mL vs. 246 ± 119.3 mL; P = 0.02). Similarly, the mean drop in hemoglobin was greater in Group I (2.38 ± 1 g/dL) than in Group II (1.5 ± 1.2 g/dL; P = 0.02). Although operative time was longer in Group I (median [95% confidence interval]: 120 [90-158.2] min vs. 96 [90-135.89] min), the difference was not statistically significant (P = 0.49). Blood transfusion was required in 4 patients in Group I and 1 patient in Group II. Intraoperative mean arterial pressure was significantly higher in Group II (110 ± 13.3 mmHg vs. 101 ± 13.7 mmHg; P = 0.02). Postoperative complications were comparable, with low rates of fever in both groups.

CONCLUSION

Vasopressin was more effective than misoprostol in reducing intraoperative blood loss and postoperative hemoglobin drop during laparoscopic myomectomy.