Skip to main content
SpringerLink
Log in

Hemodynamic effects of intramyometrial epinephrine injection for blood loss reduction in laparoscopic myomectomy

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate changes in hemodynamic effects of intramyometrial epinephrine injection for blood loss reduction in laparoscopic myomectomy.

Methods

A total of 185 women with symptomatic uterine fibroids who underwent laparoscopic myomectomy were enrolled in this study. Eighty-six women (study collective) received an intramyometrial injection of epinephrine and were compared to ninety-nine women (control collective) who underwent laparoscopic myomectomy without an intramyometrial epinephrine injection. Demographic parameters, change of hemodynamic parameters during surgery as well as hemoglobin drop after surgery were analyzed.

Results

In the study collective maximum systolic blood pressure (p < 0.001), maximum increase of the systolic blood pressure within 5 min (p = 0.003), duration of hypertension (p = 0.012), maximal (p < 0.001) and mean heart rate (p = 0.005), maximal increase of heart rate within 5 min (p = 0.003) and difference of mean to maximal heart rate (p < 0.001) were higher compared to the control collective. There was no difference in pre- and postoperative hemoglobin levels in both collectives and no intraoperative clinically relevant complication occurred due to intramyometrial epinephrine injection.

Conclusion

The intramyometrial application of epinephrine seems to be safe but leads to significant alterations of hemodynamic parameters without a significant change in postoperative hemoglobin levels.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM (2003) High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 188(1):100–107

    Article  PubMed  Google Scholar 

  2. Okolo S (2008) Incidence, aetiology and epidemiology of uterine fibroids. Best Pract Res Clin Obstet Gynaecol 22(4):571–588. https://doi.org/10.1016/j.bpobgyn.2008.04.002

    Article  PubMed  Google Scholar 

  3. Downes E, Sikirica V, Gilabert-Estelles J, Bolge SC, Dodd SL, Maroulis C, Subramanian D (2010) The burden of uterine fibroids in five European countries. Eur J Obstet Gynecol Reprod Biol 152(1):96–102. https://doi.org/10.1016/j.ejogrb.2010.05.012

    Article  PubMed  Google Scholar 

  4. Donnez J, Dolmans MM (2016) Uterine fibroid management: from the present to the future. Hum Reprod Update 22(6):665–686. https://doi.org/10.1093/humupd/dmw023

    Article  PubMed  PubMed Central  Google Scholar 

  5. Beckmann MW, Juhasz-Boss I, Denschlag D, Gass P, Dimpfl T, Harter P, Mallmann P, Renner SP, Rimbach S, Runnebaum I, Untch M, Brucker SY, Wallwiener D (2015) Surgical methods for the treatment of uterine fibroids—risk of uterine sarcoma and problems of morcellation: position paper of the DGGG. Geburtshilfe Frauenheilkd 75(2):148–164. https://doi.org/10.1055/s-0035-1545684

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Tinelli A, Mettler L, Malvasi A, Hurst B, Catherino W, Mynbaev OA, Guido M, Alkatout I, Schollmeyer T (2014) Impact of surgical approach on blood loss during intracapsular myomectomy. Minim Invasive Ther Allied Technol 23(2):87–95. https://doi.org/10.3109/13645706.2013.839951

    Article  PubMed  Google Scholar 

  7. Kalogiannidis I, Xiromeritis P, Prapas N, Prapas Y (2011) Intravaginal misoprostol reduces intraoperative blood loss in minimally invasive myomectomy: a randomized clinical trial. Clin Exp Obstet Gynecol 38(1):46–49

    CAS  PubMed  Google Scholar 

  8. Assef A (1999) Adhesions after laparoscopic myomectomy: effect of the technique used. Gynaecol Endosc 8(4):225–229

    Article  Google Scholar 

  9. Wang CJ, Lee CL, Yuen LT, Kay N, Han CM, Soong YK (2007) Oxytocin infusion in laparoscopic myomectomy may decrease operative blood loss. J Minim Invasive Gynecol 14(2):184–188. https://doi.org/10.1016/j.jmig.2006.09.016

    Article  PubMed  Google Scholar 

  10. Zullo F, Palomba S, Corea D, Pellicano M, Russo T, Falbo A, Barletta E, Saraco P, Doldo P, Zupi E (2004) Bupivacaine plus epinephrine for laparoscopic myomectomy: a randomized placebo-controlled trial. Obstet Gynecol 104(2):243–249. https://doi.org/10.1097/01.AOG.0000132801.41880.e8

    Article  CAS  PubMed  Google Scholar 

  11. Kongnyuy EJ, Wiysonge CS (2014) Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev 8:CD005355. https://doi.org/10.1002/14651858.cd005355.pub5

    Article  Google Scholar 

  12. Wong AS, Cheung CW, Yeung SW, Fan HL, Leung TY, Sahota DS (2014) Transcervical intralesional vasopressin injection compared with placebo in hysteroscopic myomectomy: a randomized controlled trial. Obstet Gynecol 124(5):897–903. https://doi.org/10.1097/AOG.0000000000000515

    Article  CAS  PubMed  Google Scholar 

  13. Kathiresan AS, Brookfield KF, Gonzalez-Quintero VH, Verma U (2011) Vasopressin versus a combination of vasopressin and tourniquets: a comparison of blood loss in patients undergoing abdominal myomectomies. Aust N Z J Obstet Gynaecol 51(1):79–83. https://doi.org/10.1111/j.1479-828X.2010.01253.x

    Article  PubMed  Google Scholar 

  14. Cohen SL, Wang KC, Gargiulo AR, Srouji S, Goggins ER, Solnik J, Tu F, Senapati S, Hur HC, Einarsson JI (2015) Vasopressin administration during laparoscopic myomectomy: a randomized controlled trial. J Minim Invasive Gynecol 22(6S):S39. https://doi.org/10.1016/j.jmig.2015.08.110

    Article  CAS  PubMed  Google Scholar 

  15. Canseco-Lima JM, Hernandez-Denis A, Audifred-Salomon J (2015) Vasopressin myoma infiltration during hysteroscopic myomectomy. J Minim Invasive Gynecol 22(6S):S123. https://doi.org/10.1016/j.jmig.2015.08.364

    Article  CAS  PubMed  Google Scholar 

  16. Frederick S, Frederick J, Fletcher H, Reid M, Hardie M, Gardner W (2013) A trial comparing the use of rectal misoprostol plus perivascular vasopressin with perivascular vasopressin alone to decrease myometrial bleeding at the time of abdominal myomectomy. Fertil Steril 100(4):1044–1049. https://doi.org/10.1016/j.fertnstert.2013.06.022

    Article  CAS  PubMed  Google Scholar 

  17. Song T, Kim MK, Kim ML, Jung YW, Yun BS, Seong SJ (2015) Use of vasopressin vs epinephrine to reduce haemorrhage during myomectomy: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 195:177–181. https://doi.org/10.1016/j.ejogrb.2015.10.003

    Article  CAS  PubMed  Google Scholar 

  18. Wenzel V, Lindner KH (2001) Employing vasopressin during cardiopulmonary resuscitation and vasodilatory shock as a lifesaving vasopressor. Cardiovasc Res 51(3):529–541

    Article  CAS  PubMed  Google Scholar 

  19. Nezhat F, Admon D, Nezhat CH, Dicorpo JE, Nezhat C (1994) Life-threatening hypotension after vasopressin injection during operative laparoscopy, followed by uneventful repeat laparoscopy. J Am Assoc Gynecol Laparosc 2(1):83–86

    Article  CAS  PubMed  Google Scholar 

  20. Riess ML, Ulrichs JG, Pagel PS, Woehlck HJ (2011) Case report: severe vasospasm mimics hypotension after high-dose intrauterine vasopressin. Anesth Analg 113(5):1103–1105. https://doi.org/10.1213/ANE.0b013e31822cef10

    Article  PubMed  Google Scholar 

  21. Tulandi T, Beique F, Kimia M (1996) Pulmonary edema: a complication of local injection of vasopressin at laparoscopy. Fertil Steril 66(3):478–480

    Article  CAS  PubMed  Google Scholar 

  22. Jayaraman L, Sinha A, Punhani D (2013) Intramyometrial vasopressin: anesthesiologists’ nightmare. J Anaesthesiol Clin Pharmacol 29(1):135–136. https://doi.org/10.4103/0970-9185.105832

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lurie S, Mamet Y (2000) Transient myocardial ischemia may occur following subendometrial vasopressin infiltration. Eur J Obstet Gynecol Reprod Biol 91(1):87–89

    Article  CAS  PubMed  Google Scholar 

  24. Nassif J, Nahouli H, Khalil A, Mikhael E, Gharzeddine W, Ghaziri G (2017) Epinephrine-induced takotsubo cardiomyopathy during laparoscopic myomectomy: case report and review of the literature. J Minim Invasive Gynecol 24(6):1037–1039. https://doi.org/10.1016/j.jmig.2017.04.024

    Article  PubMed  Google Scholar 

  25. Chudnoff S, Glazer S, Levie M (2012) Review of vasopressin use in gynecologic surgery. J Minim Invasive Gynecol 19(4):422–433

    Article  PubMed  Google Scholar 

Download references

Funding

There was no funding involved in the conduction of this study.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Jana Nickol, Sebastian Berlit, Amadeus Hornemann, Marc Sütterlin & Benjamin Tuschy

  2. Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    Stefanie Lis

  3. Department of Anesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany

    Charalambos Tsagogiorgas

Authors
  1. Jana Nickol
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastian Berlit
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefanie Lis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amadeus Hornemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charalambos Tsagogiorgas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marc Sütterlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Benjamin Tuschy
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JN: protocol development, manuscript writing. SB: manuscript editing. SL: data analysis. AH: data collection. CT: protocol development. MS: protocol development. BT: manuscript writing, protocol development.

Corresponding author

Correspondence to Jana Nickol.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was given by the Ethics Committee II at Heidelberg University, Heidelberg, Germany on 8 May 2018, reference number 2018-838R-MA.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nickol, J., Berlit, S., Lis, S. et al. Hemodynamic effects of intramyometrial epinephrine injection for blood loss reduction in laparoscopic myomectomy. Arch Gynecol Obstet 298, 933–938 (2018). https://doi.org/10.1007/s00404-018-4891-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-018-4891-5

Keywords

Search

Navigation