Paracervical Vasopressin Injection Compared With Intramyometrial Vasopressin in Abdominal Myomectomy

Paracervical Vasopressin Injection Compared With Intramyometrial Vasopressin in Abdominal Myomectomy: A Randomized Controlled Trial

The goal of the investigators study is to evaluate the effectiveness of paracervical injection of vasopressin at the time of abdominal myomectomy to decrease blood loss. The investigators will continue to use intramyometrial vasopressin as this has previously been shown to be effective. The study will not exceed the safely documented dose of vasopressin.

Study Overview

• Status: Withdrawn
• Conditions: Myoma
• Intervention / Treatment: Drug: Vasopressins

Detailed Description

After the initial physician consultation and investigations have been completed, the treatment options will be reviewed with the patient. If the patient chooses to proceed with an abdominal myomectomy, then she will be offered participation in the study.

If she chooses to participate, the patient will undergo routine pre-operative assessments including either transvaginal ultrasound or pelvic MRI. The pre-operative hemoglobin level will be measured within at least 2 weeks of the operative procedure.

Randomization to either the vasopressin group or the placebo group will be carried out in the operating room by assigning each recruited patient a consecutively numbered, sealed opaque envelope, which will contain the designated treatment as determined by a computer-generated series of random numbers. The randomization will be performed by an independent member of the division that is not involved in the study.

At the time of induction of anesthesia, a sealed envelope will be opened by the research fellow. At the time of induction of anesthesia, the sealed envelope will be opened to reveal the randomization to only the research fellow. The attending physician will remain blinded. The research fellow will prepare either the placebo solution or the vasopressin and will be responsible for performing the paracervical injection. The attending physician will be responsible for recording the surgeon rate of bleeding, the total ebl, and the total operating time.

In the both groups, one vial (20 units) of vasopressin will be diluted to 40mL with normal saline solution. Not more than 16mL (8units) of vasopressin will be used. This dose was chosen as there is no standard vasopressin dose routinely used. The dose is well below the maximum amount of vasopressin used, and at a level that few complications have been seen in the past.

Given it is standard practice for all patients to receive intramyometrial vasopressin injections, both groups will have the medication ordered and prepared. In the patients randomized to paracervical vasopressin, 8mL (4mL per side of the cervix) will be injected using a 22F spinal needle. An additional 8mL (4 units) will be injected in intramyometrial as this is standard of care in our practice. In the patients randomized to no paracervical vasopressin, 16mL (8 units) will then be used to inject vasopressin intramyometrial prior to the myomectomy. This will help determine if the routine of delivery of vasopressin will aid in decreased blood loss.

The operative case will otherwise proceed in the standard fashion. The total ebl, total operative time, and myomectomy operative time will all be recorded. The myomectomy operative time will be recorded from the time of the first incision on the uterus, to complete closure of any uterine defects.

• Study Type: Interventional
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Ohio
    • Beachwood, Ohio, United States, 44122
      • University Hospitals Fertility Center
    • Cleveland, Ohio, United States, 44117
      • University Hospitals

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Age 18-60 years old
• All women who are candidates for abdominal myomectomy and are willing to accept randomization

Exclusion Criteria:

• Patients unable to consent for the study
• Suspected malignancy
• History of adverse reaction or allergy to vasopressin
• Active cardiovascular or pulmonary disease that would indicate a contraindication to use of vasopressin

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Paracervical & Intramyometrial; Vasopressin will be placed paracervically (8mL, 4 units) and intramyometrial (8mL, 4 units)	Drug: Vasopressins; Either paracervical and intramyometrial or intramyometrial alone at time of abdominal myomectomy.; Other Names: vasopressin
Active Comparator: Intramyometrial; Vasopressin will be placed intramyometrial (16mL, 8 units)	Drug: Vasopressins; Either paracervical and intramyometrial or intramyometrial alone at time of abdominal myomectomy.; Other Names: vasopressin

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
1. Estimating blood loss at the end of myomectomy (calculated as [total suction canister volume] +[laparotomy pads] - [volume of irritation used] - [volume of vasopressin used])	1 day

Secondary Outcome Measures

Outcome Measure	Time Frame
Change in Hgb and Hct post-operatively from pre-operative level	1- 2 days
Peri-operative complications	2 days
Total operation time (time from incision to end of surgery)	1 day

Collaborators and Investigators

• Sponsor: University Hospitals Cleveland Medical Center

Study record dates

Study Major Dates

• Study Start: March 1, 2015
• Primary Completion (Anticipated): March 1, 2017

Study Registration Dates

• First Submitted: February 25, 2015
• First Submitted That Met QC Criteria: March 2, 2015
• First Posted (Estimate): March 3, 2015

Study Record Updates

• Last Update Posted (Actual): May 12, 2022
• Last Update Submitted That Met QC Criteria: May 6, 2022
• Last Verified: May 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Natriuretic Agents; Hemostatics; Coagulants; Vasoconstrictor Agents; Antidiuretic Agents; Vasopressins; Arginine Vasopressin
• Other Study ID Numbers: 043231