A Randomized Clinical Trial Comparing the Effect of Rectal Misoprostol with Intramyometrial Vasopressin on Blood Loss during Laparoscopic Myomectomy

Objectives: This study aimed to compare the efficacy of rectal misoprostol combined with intramyometrial normal saline versus intramyometrial vasopressin in reducing blood loss during laparoscopic myomectomy. Materials and Methods: This was a randomized, double blind, controlled trial (CTRI/2023/05/053204). A total of 70 women scheduled for laparoscopic myomectomy were enrolled and equally randomized into two groups: Group I (received rectal misoprostol 400 µg 1 h before surgery) and Group II (received intramyometrial vasopressin 20 IU in 200 ml NS dilution). Final analysis was conducted on 64 patients due to missing data (4 in Group I and 2 in Group II). The primary outcome was intraoperative blood loss. Results: Baseline clinical characteristics were similar between the groups. Intraoperative blood loss was significantly higher in the misoprostol Group I compared to the vasopressin Group II (320.9 ± 131.9 mL vs. 246 ± 119.3 mL; P = 0.02). Similarly, the mean drop in hemoglobin was greater in Group I (2.38 ± 1 g/dL) than in Group II (1.5 ± 1.2 g/dL; P = 0.02). Although operative time was longer in Group I (median [95% confidence interval]: 120 [90–158.2] min vs. 96 [90–135.89] min), the difference was not statistically significant ( P = 0.49). Blood transfusion was required in 4 patients in Group I and 1 patient in Group II. Intraoperative mean arterial pressure was significantly higher in Group II (110 ± 13.3 mmHg vs. 101 ± 13.7 mmHg; P = 0.02). Postoperative complications were comparable, with low rates of fever in both groups. Conclusion: Vasopressin was more effective than misoprostol in reducing intraoperative blood loss and postoperative hemoglobin drop during laparoscopic myomectomy.