Local Epinephrine Versus Uterine Artery Tourniquet to Reduce Bleeding During Myomectomy: A Prospective Clinical Trial

Abstract

Objective: Despite the availability of interventions for controlling bleeding during myomectomy, the superiority of one over another is still unclear. Materials and Methods: This prospective study was conducted at Mansoura University Hospital, Mansoura, Egypt, between July 2019 and July 2021, after approval from the Mansoura Faculty of Medicine Institutional Research Board (IRB: MS.19.05.629) on 40 cases divided into two equal groups. Patients in the tourniquet group: A Foley catheter of 16F size surrounded the cervix at the level of the internal os and tightened to occlude the uterine arteries. The epinephrine group: a solution of 1/250,000 epinephrine )produced by dilution of 1 ampule epinephrine(1mg/1ml Epinephrine: chemical industries development (CID), Giza, Egypt) in 250 ml saline( was infiltrated at the myoma bed and beneath the covering myometrium until the infiltrated areas became paler. Results: The blood loss was significantly lower in the epinephrine group (362.50± 61.12) versus (452.95± 70.72) ( p < 0.001). Blood transfusion was non significantly higher in the tourniquet group (55%) versus (25%) ( p = 0.053). The operative time was considerably shorter ( p < 0.001) in the epinephrine group (36.65±4.38) compared with the tourniquet group (41.65±3.77). The hospital stay wasn’t statistically longer in the tourniquet group compared to the epinephrine group (2(1-3)) (1(1-2)) respectively, ( p = 0.147. Fortunately, no cases of hysterectomy or relaparotomy in both groups. Conclusion: Injecting Epinephrine during myomectomy reduces intraoperative blood loss and blood transfusion and shortens the operative time.