Terlipressin infusion during whipple procedure : effect on blood loss and transfusion needs-a randomized clinical trial

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.