# Preoperative Intravenous Desmopressin and Perioperative Blood Loss in Patients Undergoing Major Spine Surgery: Preoperative Intravenous Desmopressin and Perioperative Blood Loss in Spine Surgery Patients

## TL;DR

This study shows that preoperative desmopressin reduces blood loss and transfusion needs during major spine surgery without major side effects.

## Contribution

The study provides new evidence for desmopressin's efficacy in reducing intraoperative blood loss in spine surgery.

## Key findings

- Desmopressin significantly reduced intraoperative blood loss during the first and second hours of surgery.
- Transfusion volume and intraoperative packed red blood cell use were lower in the desmopressin group.
- Postoperative creatinine levels were lower in the desmopressin group, with no significant adverse effects.

## Abstract

Major spine surgeries often involve significant blood loss, increasing
transfusion risks and postoperative complications. Desmopressin, a synthetic
vasopressin analog, may reduce bleeding by enhancing clotting factor
release, but its efficacy in spine surgery remains understudied. This study
evaluated the efficacy of preoperative intravenous desmopressin in reducing
perioperative blood loss and transfusion requirements in patients undergoing
major spine surgery.

A double-blind, randomized, placebo-controlled trial was conducted at Shahid
Rajaei Hospital, Iran. Fifty-five patients undergoing major spinal surgery
were randomized to receive either 0.3 μg/kg desmopressin (n=25) or placebo
(n=30) during anesthesia induction. Primary outcomes included intraoperative
blood loss (measured hourly) and transfusion volume. Secondary outcomes
included postoperative sodium levels, creatinine, urine output, and hospital
stay. Statistical analyses used Student’s t-test, Chi-square, and repeated
measures ANOVA.

Desmopressin significantly reduced intraoperative blood loss during the first
hour (336.00± 125.43 vs. 398.33±85.58 mL, P=0.034) and second hour
(530.95±188.07 vs. 756.67 ± 242.65 mL, P=0.003) compared to placebo. Total
transfusion volume was lower in the desmopressin group (724.79 ± 429.06 vs.
1396.55±325.94 mL, P=0.001), with fewer intraoperative packed red blood cell
transfusions (16% vs. 40%, P = 0.050). Postoperative creatinine levels were
lower with desmopressin (1.16 ± 0.30 vs. 1.40 ± 0.32 mg/dL, P=0.009), but
sodium levels and urine output were comparable. Hemodynamic stability and
hospital stay did not differ significantly.

Preoperative desmopressin reduced early intraoperative blood loss and
transfusion requirements in major spine surgery without significant adverse
effects. These findings support its use as a hemostatic adjunct, though
further studies are needed to confirm long-term safety and efficacy.