Lidocaine plus epinephrine for abdominal myomectomy effective in reducing blood loss
New research has found that a combination saline solution of lidocaine and epinephrine during abdominal myomectomy appears to have clear and strong signals of safety and efficacy in reducing blood loss.
Intraoperative bleeding during myectomy has been reported to lead to adverse consequences for patients, including complicated operations, the need for transfusion, uterine rupture, and prolonged hospitalizations.
“In fact, this study revealed promising results, supporting the efficacy of a safe, cost-effective, available and easy-to-use intervention,” wrote study author Gelareh Biazar, Center for Anesthesiology Research, Department of Anaesthesiology, Al-Zahra Hospital. , Guilan University of Medical Sciences. “However, further studies should answer several unanswered questions about the choice of local anesthetics, the optimal dosage, the most effective method and timing of drug administration, and which cases benefit most from this intervention.
The ongoing randomized double-blind clinical study aimed to determine the effects of lidocaine plus epinephrine on intraoperative bleeding during the procedure at a referral hospital and academic center between October 2019 and May 2020.
The patients included were women aged 18 to 50, candidates for elective abdominal myomectomy, intramural fibroids > 5 cm and symptomatic fibroids. They were randomly divided into 2 groups of lidocaine plus epinephrine (L) and placebo (P) based on block randomization of 4.
For group L, lidocaine 3 mg/kg plus 0.5 ml epinephrine with saline reached 50 cc and in group P, 50 ml normal saline was used. Solution and normal saline were infiltrated into the grave and myometrium above and around the fibroid before incision.
Baseline hemoglobin values were measured and compared at four hours postoperatively to detect bleeding severity. A sample size of 30 patients in each group was deemed sufficient by the investigators.
No significant differences between the groups in terms of demographic data were identified. Investigators found changes in hemoglobin (P <.0001 and the degree of difficulty surgery>P = 0.01) were significantly lower in group L than in group P.
In addition, in each group, the decline in hemoglobin levels between baseline and 4 hours postoperatively was significant (P <.0001 a significant correlation was also observed between changes in hemoglobin and the degree of difficulty surgery with size uterus fibroids>P <.05>
Meanwhile, a negative correlation has been reported between pregnancy and difficulty of surgery (r = -0.413; P = .02). The duration of surgery was longer in group P compared to group L was 70.66 ± 19.85 versus 66.16 ± 14.48, respectively. The difference was not scored as significant (P = 0.32).
No serious adverse effects were reported in either group, while hemodynamic parameters were maintained within the normal range throughout surgery.
The study, “Safety and efficacy of lidocaine plus epinephrine on intraoperative bleeding in abdominal myomectomy: a double-blind clinical trialwas published in Health Sciences Reports.