Preoperative Intravenous Desmopressin and Perioperative Blood Loss in Patients Undergoing Major Spine Surgery : Preoperative Intravenous Desmopressin and Perioperative Blood Loss in Spine Surgery Patients.

BACKGROUND

Major spine surgeries often involve significant blood loss, increasing transfusion risks and postoperative complications. Desmopressin, a synthetic vasopressin analog, may reduce bleeding by enhancing clotting factor release, but its efficacy in spine surgery remains understudied. This study evaluated the efficacy of preoperative intravenous desmopressin in reducing perioperative blood loss and transfusion requirements in patients undergoing major spine surgery.

MATERIALS AND

METHODS

A double-blind, randomized, placebo-controlled trial was conducted at Shahid Rajaei Hospital, Iran. Fifty-five patients undergoing major spinal surgery were randomized to receive either 0.3 μg/kg desmopressin (n=25) or placebo (n=30) during anesthesia induction. Primary outcomes included intraoperative blood loss (measured hourly) and transfusion volume. Secondary outcomes included postoperative sodium levels, creatinine, urine output, and hospital stay. Statistical analyses used Student's t-test, Chi-square, and repeated measures ANOVA.

RESULTS

Desmopressin significantly reduced intraoperative blood loss during the first hour (336.00± 125.43 vs. 398.33±85.58 mL, P=0.034) and second hour (530.95±188.07 vs. 756.67 ± 242.65 mL, P=0.003) compared to placebo. Total transfusion volume was lower in the desmopressin group (724.79 ± 429.06 vs. 1396.55±325.94 mL, P=0.001), with fewer intraoperative packed red blood cell transfusions (16% vs. 40%, P = 0.050). Postoperative creatinine levels were lower with desmopressin (1.16 ± 0.30 vs. 1.40 ± 0.32 mg/dL, P=0.009), but sodium levels and urine output were comparable. Hemodynamic stability and hospital stay did not differ significantly.

CONCLUSION

Preoperative desmopressin reduced early intraoperative blood loss and transfusion requirements in major spine surgery without significant adverse effects. These findings support its use as a hemostatic adjunct, though further studies are needed to confirm long-term safety and efficacy.