Efficacy of prophylactic pre-operative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: A systematic review and meta-analysis of randomised placebo-controlled trials

Abdullah Abdulaziz Alrajhi; Abdullah Shakhs Alghamdi; Mohammed Hassan Baali; Abdulaziz Fahad Altowairqi; Meshal Fahad Khan; Ahmad Saad Alharthi; Ebraheem Albazee; Ahmed Abu-Zaid

doi:10.1111/coa.14020

Efficacy of prophylactic pre-operative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: A systematic review and meta-analysis of randomised placebo-controlled trials

Clin Otolaryngol. 2023 Mar;48(2):139-150. doi: 10.1111/coa.14020. Epub 2023 Jan 3.

Authors

Abdullah Abdulaziz Alrajhi¹, Abdullah Shakhs Alghamdi², Mohammed Hassan Baali³, Abdulaziz Fahad Altowairqi⁴, Meshal Fahad Khan¹, Ahmad Saad Alharthi², Ebraheem Albazee⁵, Ahmed Abu-Zaid^{6

7}

Affiliations

¹ Department of Otolaryngology and Head and Neck Surgery, Al-Noor Specialist Hospital, Makkah, Saudi Arabia.
² Department of Otolaryngology and Head and Neck Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia.
³ Department of Otolaryngology and Head and Neck Surgery, King Faisal Medical Complex, Taif, Saudi Arabia.
⁴ Department of Otolaryngology and Head and Neck Surgery, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia.
⁵ Kuwait Institute for Medical Specializations, Kuwait City, Kuwait.
⁶ College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
⁷ College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA.

PMID: 36536598
DOI: 10.1111/coa.14020

Abstract

Objectives: To examine the efficacy of prophylactic desmopressin versus placebo among patients undergoing functional endoscopic sinus surgery (FESS).

Design: Systematic review and meta-analysis of randomised controlled trials (RCTs).

Setting: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science databases were screened from inception until 18 March 2022.

Participants: Patients undergoing FESS.

Main outcome measures: Primary efficacy endpoints comprised intraoperative blood loss, visual clarity, and operation time. Secondary endpoints comprised side effects. The efficacy endpoints were summarised as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI).

Results: Five RCTs comprising 380 patients (desmopressin = 191 patients and placebo = 189 patients) were included. Collectively, the included RCTs had an overall low risk of bias. The pooled results showed that the mean intraoperative blood loss (n = 5 RCTs, MD = -37.97 ml, 95% CI [-56.97, -18.96], p < .001), 5-point Boezaart scores (n = 2 RCTs, MD = -.97, 95% CI [-1.21, -.74], p < .001), and 10-point Boezaart scores (n = 2 RCTs, MD = -3.00, 95% CI [-3.61, -2.40], p < .001) were significantly reduced in favour of the desmopressin group compared with the placebo group. Operation time did not significantly differ between both groups (n = 5 RCTs, MD = -3.73 min, 95% CI [-14.65, 7.18], p = .50). No patient in both groups developed symptomatic hyponatremia (n = 3 RCTs, 194 patients) or thromboembolic events (n = 2 RCTs, 150 patients).

Conclusions: Among patients undergoing FESS, prophylactic administration of desmopressin does not correlate with significant clinical benefits. Data on safety is limited. Future research may explore the synergistic antihaemorrhagic efficacy and safety of tranexamic acid (TXA) plus desmopressin versus TXA alone among patients undergoing FESS.

Keywords: blood loss; chronic rhinosinusitis; desmopressin; functional endoscopic sinus surgery; surgical field.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Blood Loss, Surgical / prevention & control
Deamino Arginine Vasopressin / therapeutic use
Hemostatics* / therapeutic use
Humans
Randomized Controlled Trials as Topic
Tranexamic Acid* / therapeutic use

Substances

Deamino Arginine Vasopressin
Hemostatics
Tranexamic Acid