Context
Multivisceral resections including Whipple procedure are among the foremost common
oncologic procedures during which massive bleeding and transfusion might happen
intraoperatively or postoperatively. Terlipressin is a synthetic vasopressin analog with relative
specificity for the splanchnic circulation where it causes vasoconstriction, with a hypothetical
reduction in blood loss during abdominal surgeries.
Aims
We aim to assess the effect of terlipressin infusion on blood loss and blood transfusion
requirements during Whipple procedure.
Settings and design
The current study was a prospective single center randomized placebo‑controlled trial. The
study was carried out in Al Rajhy Liver Hospital, Assiut University, Egypt between May 2016
and July 2017.
Patients and methods
In this trial 40 patients scheduled for Whipple procedure were randomly assigned either to
receive terlipressin at the beginning of surgery as an initial bolus dose of (1 mg over 30 min)
followed by a continuous infusion of 2 μg/kg/h throughout the procedure and gradually weaned
over the first 4 h postoperatively (terlipressin group) or to receive the same volume and rate
of 0.9% saline for the same duration (control group).The primary outcome was the amount
of intraoperative blood loss.
Statistical analysis used
Statistical analysis was established using SPSS, version 16.0.
Results
The amount of intraoperative blood loss was significantly lower in the terlipressin
group (690.00 ± 449.44) in comparison with the control group (1020.00 ± 284.88). Five (25%)
patients received blood transfusion in the terlipressin group compared with 13 (65%) patients
in the control group (P = 0.011). Significantly greater number of packed red blood cells units
were transfused to the control group (P = 0.013).
Conclusion
Terlipressin infusion during Whipple procedure was associated with less bleeding and lower
rates of blood transfusion requirements compared with placebo.
Keywords:
blood loss, terlipressin, transfusion needs, Whipple procedure