open access

Ahead of Print
Research paper
Published online: 2021-10-07
Get Citation

Epidural anaesthesia and myomectomy-associated blood loss: — a prospective randomised controlled study

Mohamed Farghali1, Abdelrady S Ibrahim2, Waleed S Farrag2
DOI: 10.5603/GP.a2021.0186
Affiliations
  1. Faculty of Medicine, Ain Shams University, Abbassia, Egypt
  2. Assiut University Hospital, Faculty of Medicine, Assiut, Egypt

open access

Ahead of Print
ORIGINAL PAPERS Gynecology
Published online: 2021-10-07

Abstract

Objectives: The management of anaesthesia for patients with large myomas is particularly important due to disruption of hemodynamic as a result of massive haemorrhage, the prolonged duration of surgery and requirement for additional interventions. This study evaluated the effect of anaesthetic technique on blood loss in patients undergoing myomectomy due to large fibroid uterus.

Material and methods: A total of 156 patients that underwent myomectomy were randomized into two equal groups according to the type of anaesthesia: Epidural anaesthesia group and General anaesthesia group. The volume of blood loss and blood products transfusion was reviewed for each patient.

Results: The intraoperative blood loss and need for blood transfusion were significantly higher in general anaesthesia group (p < 0.001). The mean hematocrit change was 2.5 ± 1.5 vs 3.7 ± 2.9 % (p = 0.001) for both groups.

Conclusions: In the myomectomy planning of women with a large fibroid uterus, the team of gynecologists and anaesthesiologists should take care to choose the most optimal technique for anaesthesia.

Abstract

Objectives: The management of anaesthesia for patients with large myomas is particularly important due to disruption of hemodynamic as a result of massive haemorrhage, the prolonged duration of surgery and requirement for additional interventions. This study evaluated the effect of anaesthetic technique on blood loss in patients undergoing myomectomy due to large fibroid uterus.

Material and methods: A total of 156 patients that underwent myomectomy were randomized into two equal groups according to the type of anaesthesia: Epidural anaesthesia group and General anaesthesia group. The volume of blood loss and blood products transfusion was reviewed for each patient.

Results: The intraoperative blood loss and need for blood transfusion were significantly higher in general anaesthesia group (p < 0.001). The mean hematocrit change was 2.5 ± 1.5 vs 3.7 ± 2.9 % (p = 0.001) for both groups.

Conclusions: In the myomectomy planning of women with a large fibroid uterus, the team of gynecologists and anaesthesiologists should take care to choose the most optimal technique for anaesthesia.

Get Citation

Keywords

epidural anaesthesia; general anaesthesia; myomectomy; blood loss

About this article
Title

Epidural anaesthesia and myomectomy-associated blood loss: — a prospective randomised controlled study

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Research paper

Published online

2021-10-07

DOI

10.5603/GP.a2021.0186

Keywords

epidural anaesthesia
general anaesthesia
myomectomy
blood loss

Authors

Mohamed Farghali
Abdelrady S Ibrahim
Waleed S Farrag

References (26)
  1. Parker WH. Uterine myomas: management. Fertil Steril. 2007; 88(2): 255–271.
  2. Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev. 2011(11): CD005355.
  3. Rock JA, Jones HW. Te Linde's operative gynecology. Wolters Kluwer Health/Lippincott Williams & Wilkins 2008.
  4. Adesina KT, Owolabi BO, Raji HO, et al. Abdominal myomectomy: A retrospective review of determinants and outcomes of complications at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. 2017; 29(1): 37–42.
  5. Omole-Ohonsi A, Ashimi OA. Non-emergency hysterectomy: why the aversion? Arch Gynecol Obstet. 2009; 280(6): 953–959.
  6. Kunde K, Cortes E, Seed P, et al. Evaluation of perioperative morbidity associated with single and multiple myomectomy. J Obstet Gynaecol. 2009; 29(8): 737–741.
  7. Balogun OR, Nwachukwu CND. Surgical findings at laparatomy for uterine fibroid in University of Ilorin Teaching Hospital . Trropical Journal of Health Sciences. 2006; 13(2): 27–30.
  8. Ikechebelu JI, Ezeama CO, Obiechina NJA. The use of torniquet to reduce blood loss at myomectomy . The use of torniquet to reduce blood loss at myomectomy. 2010; 13(2): 13.
  9. Choi WS, Samman N. Risks and benefits of deliberate hypotension in anaesthesia: a systematic review. International Journal of Oral and Maxillofacial Surgery. 2008; 37(8): 687–703.
  10. Ervens J, Marks C, Hechler M, et al. Effect of induced hypotensive anaesthesia vs isovolaemic haemodilution on blood loss and transfusion requirements in orthognathic surgery: a prospective, single-blinded, randomized, controlled clinical study. Int J Oral Maxillofac Surg. 2010; 39(12): 1168–1174.
  11. Quinn SD, Vedelago J, Kashef E, et al. Measurement of uterine fibroid volume: a comparative accuracy and validation of methods study . Eur J Obstet Gynecol Reprod Biol. 2013; 171(1): 161–165.
  12. Nadler SB, Hidalgo JU, Bloch TJS. Prediction of blood volume in normal human adults. Surgery. 1962; 51(2): 224–232.
  13. Gross JB. Estimating allowable blood losscorrected for dilution. Anesthesiology. 1983; 58(3): 277–280.
  14. Freeman AK, Thorne CJ, Gaston CL, et al. Hypotensive epidural anesthesia reduces blood loss in pelvic and sacral bone tumor resections. Clin Orthop Relat Res. 2017; 475(3): 634–640.
  15. Davids A. Myomectomy; surgical technique and results in a series of 1,150 cases. American Journal of Obstetrics and Gynecology. 1952; 63(3): 592–604.
  16. Varol N, Healey M, Tang P, et al. Ten-year review of hysterectomy morbidity and mortality: can we change direction? Aust N Z J Obstet Gynaecol. 2001; 41(3): 295–302.
  17. Feltracco P, Carollo C, Barbieri S, et al. Early respiratory complications after liver transplantation. World Journal of Gastroenterology. 2013; 19(48): 9271.
  18. Celik H, Sapmaz E. Use of a single preoperative dose of misoprostol is efficacious for patients who undergo abdominal myomectomy. Fertility and Sterility. 2003; 79(5): 1207–1210.
  19. Niroomand N, Hajiha S, Tabrizi NM, et al. A single dose of misoprostol for reducing hemorrhage during myomectomy: a randomized clinical trial. Arch Gynecol Obstet. 2015; 292(1): 155–158.
  20. Abdel-Hafeez M, Elnaggar A, Ali M, et al. Rectal misoprostol for myomectomy: A randomised placebo-controlled study. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2015; 55(4): 363–368.
  21. Bonner SM, Haynes SR, Ryall D. The anaesthetic management of Caesarean section for placenta praevia: a questionnaire survey. Anaesthesia. 2007; 50(11): 992–994.
  22. Chestnut DH, Dewan DM, Redick LF, et al. Anesthetic management for obstetric hysterectomy: a multi-institutional study . Anesthesiology. 1989; 70(4): 607–610.
  23. Lilker S, Meyer R, Downey K, et al. Anesthetic considerations for placenta accreta . Int J Obstet Anesth. 2011; 20(4): 288–92.
  24. Ciarmela P, Islam MdS, Reis FM, et al. Growth factors and myometrium: biological effects in uterine fibroid and possible clinical implications. Hum Reprod Update. 2011; 17(6): 772–790.
  25. Carmeliet P, Jain R. Angiogenesis in cancer and other diseases. Nature. 2000; 407(6801): 249–257.
  26. Zhang Y, Yu J, Yang F, et al. Effect of anesthetic technique on serum vascular endothelial growth factor C and prostaglandin E2 levels in women undergoing surgery for uterine leiomyomas. J Int Med Res. 2020; 48(4): 300060520918420.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl