Lidocaine Plus Epinephrine for Abdominal Myomectomy Effective in Reducing Blood Loss

Hemoglobin changes and the degree of surgery difficulty were significantly lower in the lidocaine plus epinephrine group compared with placebo.

New research found a combination saline solution of lidocaine plus epinephrine during abdominal myomectomy appeared to have clear, strong safety and efficacy signals in reducing blood loss.

Intraoperative bleeding during myectomy has been reported to lead to adverse consequences for patients, including complicated operations, the need for transfusion, uterine rupture, and prolonged hospitalizations.

“In fact, this study revealed promising findings, supporting the efficacy of a safe, cost‐effective, available, and easy‐to‐use intervention,” wrote study author Gelareh Biazar, Anesthesiology Research Center, Department of Anesthesiology, Al‐Zahra Hospital, Guilan University of Medical Sciences. “However, further studies should address several unanswered questions about the choice of local anesthetics, the optimal dosage, the most effective method and timing of drug administration, and certain cases that benefit most from this intervention.

The current randomized, double-blind clinical study aimed to determine the effects of lidocaine plus epinephrine on intraoperative bleeding in the procedure at a referral hospital and academic center between October 2019 - May 2020.

Patients who were included were women 18 to 50 years old, candidates for elective abdominal myomectomy, intramural fibroids >5 cm, and symptomatic fibroids. They were randomly divided into 2 groups of lidocaine plus epinephrine (L) and placebo (P) based on randomization in blocks of 4.

For group L, lidocaine 3 mg/kg plus 0.5 mL of adrenaline with saline solution reached 50 ccs and in group P, 50 mL of normal saline was used. Both the solution and normal saline were infiltrated to the serious and myometrium above and around the fibroid before incision.

The baseline hemoglobin values were measured and compared with four hours post-operation to detect the severity of bleeding. A sample size of 30 patients in each group was deemed sufficient by the investigators.

No significant differences between the groups in terms of demographic data were identified. Investigators found hemoglobin changes (P <.0001) and in the degree of surgery difficulty (P = .01) were significantly lower in Group L compared with Group P.

Further, in each group, the drop in hemoglobin levels from baseline to 4 hour postoperatively was significant (P <.0001). A significantly meaningful correlation was additionally observed between hemoglobin changes and the degree of surgery difficulty with the size of the uterine and fibroids (P <.05).

Meanwhile, a negative correlation was reported between gravidity and surgery difficulty (r = -0.413; P = .02). The surgery duration was longer in Group P compared with Group L was 70.66 ± 19.85 versus 66.16 ± 14.48, respectively. The difference was not noted as significant (P = .32).

There were no serious adverse reactions reported in either group, while hemodynamic parameters were kept within the normal range throughout the surgery.

The study, “Safety and efficacy of lidocaine plus epinephrine on intraoperative bleeding in abdominal myomectomy: A double-blind clinical trial,” was published in Health Science Reports.