Ornipressin (Por. 8) for Haemostatic Infiltration in Neurosurgery

Abstract

A double blind controlled trial was carried out on 100 neurosurgical patients. Ornipressin 0•2 IU Iml was compared with adrenaline 1 : 250,000. Ornipressin proved to be as effective as the control agent, and had little systemic effect. It is concluded that absence of arrhythmigenicity makes ornipressin preferable to adrenaline.

A Comparative Study of the Haemostatic Properties and Cardiovascular Effects of Adrenaline and Ornipressin in Children during Enflurane Anaesthesia

“…Several reports appeared in the literature about 10 years ago which suggested that the infiltration of ornipressin satisfactorily reduced bleeding during surgery but few of these were controlled clinical trials (REA 1969, MCCAFFREY 1970, SHIELL 1971. However, in one double-blind trial, TORDA et al (1972) did show that ornipressin and adrenaline were equally efficient haemostatic agents during a variety of neurosurgical procedures.…”

The pharmacology of ornipressin (POR-8): a local vasoconstrictor used in surgery

“…Effective cutaneous vasoconstriction may be observed at drug concentrations as low as 0.0001 IU mL –1 , and maximal vasoconstriction occurs at concentrations between 0.01 and 0.1 IU mL –1 , depending on interindividual variability. The local vasoconstrictor action of ornipressin is approximately equal to that of adrenaline [12–16]. Thus, ornipressin is used to produce local haemostasis to reduce blood loss and provide a bloodless surgical field.…”

“…The localized vasoconstrictor activity of ornipressin, when used topically or by infiltration, has been utilized in a wide range of surgical procedures. In general, most studies have shown that ornipressin is at least similar to adrenaline in its vasoconstrictor action and with fewer side effects [12–16].…”

“…In neurosurgery, infiltration of the scalp with vasoconstrictors is frequently employed to reduce blood loss. A double‐blind controlled study [14] showed no significant differences in terms of blood loss and operative conditions when lignocaine 0.5% with ornipressin (0.2 IU mL –1 ) was compared with lignocaine 0.5% with adrenaline [1:250 000] for infiltration of the scalp. However, three patients who had infiltration with the solution containing adrenaline developed minor cardiac arrhythmias, while none in the ornipressin group displayed this adverse effect.…”

“…In an early multi‐centre trial [12], the incidence of cardiac arrhythmias associated with ornipressin was reported to be less than 1%, in contrast with the reported incidence of 11% associated with adrenaline [1:200 000] when used in patients anaesthetized with halothane [35]. Most studies [9,14,16] using the recommended dose range have not shown serious rhythm disturbances associated with ornipressin, even in the presence of halothane. Anecdotal evidence of arrhythmias following the administration of ornipressin exists [36].…”