Pharmacological options to reduce blood loss in laparoscopic myectomy

Czech version

Authors: Miroslav Ščerba
Authors‘ workplace: Gynekologicko-porodnické oddělení Nemocnice ve Frýdku-Místku, p. o.
Published in: Prakt Gyn 2013; 17(4): 297-300
Category: Gynecology and Obstetrics: Review Article

Overview

Bleeding during hysterotomy is one of peroperational complications of laparoscopic myomectomy. It is possible to pharmacologically reduce the risk of blood loss during laparoscopic myomectomy. The thesis compares the available data about the usage of the individual medicaments, their effects and the risks associated with their application. The medicaments used for the reduction of blood loss can be divided according to the period of their usage into three following groups: the ones with preoperational, peroperational, and post-operational usage. Preoperational pharmacological preparation of GnRH analogy can suppress the extension of myomatosis so as to make laparoscopic access possible, but at the same time it does not reduce the blood loss as such with women indicated for laparoscopic myomectomy. Better results are brought by preoperational preparation of SPRM, the effect of which is more selective and more long-lasting in comparison with GnRH and which do not arouse so much of the undesired hyaline degeneration of myoms, which complicates their laparoscopic enucleation, as the GnRH analogues do. The peroperational usage of vasopresin is an effective method of reducing blood loss, which is, though, associated with the risk of serious cardiovascular complications. A clinically safer medicament from the group of vasoconstrictors is epinephrine. When tempered with water at the ratio of 1 : 200,000, epinephrine in combination with a local anaesthetic does not only reduce blood loss but also the length of the operation and post-surgical pain. Uterotonics are used during all phases of operational treatment of myomatosis, including immediate pharmacological preoperational preparation (e. g. by means of misoprostol). So far, though, the proof of their effect has been based on empiricism rather than on the results of thorough and prospective studies.

Key words:
epinephrine – GnRH-analogues – laparoscopic myectomy – misoprostol – vasopressin

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