Effect of milrinone-terlipressin infusion on blood loss and portal pressure during hepatic resection: a randomized controlled trial

Background: Low central venous pressure (CVP) and Pringle maneuver are commonly employed strategies to reduce bleeding during hepatic resection. Milrinone and terlipressin lower hepatic venous pressure and portal venous pressure (PVP), thereby reducing the risk of bleeding. This study compared the intraoperative blood loss between a combined infusion of milrinone and terlipressin, and terlipressin alone in patients undergoing elective hepatic resection.Methods: A total of 36 patients were randomized to the Milrinone and terlipressin or Terlipressin groups, who received infusions starting 30 min before the beginning of liver resection until the end of the surgery. The primary objective was to determine differences in blood loss between the two groups.Results: Thirty-four patients (17 in each group) were assessed by stratification into major and minor hepatic resections. The median (1Q, 3Q) intraoperative blood loss (in ml) was lower in Milrinone and terlipressin group than in Terlipressin group (570 [329, 880] vs. 824 [750, 1,146]; P = 0.046). In minor resections, milrinone and terlipressin had lower blood loss than terlipressin (373 [273, 556] vs. 798 [725, 1,230]; P = 0.015). There is no difference between the two groups in blood loss during major hepatic resection. The decreases in PVP and CVP at 30 min post-infusion were significant in the Milrinone and terlipressin group (P = 0.002 and P = 0.027, respectively).Conclusions: The combination of milrinone and terlipressin significantly reduces intraoperative blood loss, especially during minor hepatic resections.