Effect of Different Anesthetic Techniques on Post-operative Hemoglobin and Hematocrit Levels Following Abdominal Hysterectomy; a Randomized Clinical Trial

Document Type : Original Article


1 Associate Professor, Department of Anesthesiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.

2 Anesthesiologist, Department of Anesthesiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.

3 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.


Introduction: Hemorrhage and drop in hemoglobin (Hb) and hematocrit (Hct) levels are the major complications of hysterectomy. This study was conducted to compare the effect of different anesthetic techniques on post-operative Hb and Hct levels following abdominal hysterectomy.
Materials and Methods: This randomized clinical trial was performed on 100 women aged between 35 and 70 years old in 2013. They were classified as classes I and II according to the American Society of Anesthesiology physical status classification and were candidates for abdominal hysterectomy due to benign causes. The patients were assigned into two groups of spinal and general anesthesia (50 patients per group). The pre- and 24 h post-operative levels of Hb and Hct and systolic and diastolic blood pressure during surgery were recorded 5, 10, 15, 20, 25, 30, 40, 50, and 60 min after the onset of general and spinal anesthesia. Data analysis was performed using t-test, Mann-Whitney U and Chi-squared tests by SPSS software, version 22. P-value less than 0.05 was considered statistically significant.
Results: There was no significant different regarding age, the duration of anesthesia and surgery, mean pre-operative levels of Hb and Hct (P>0.05). The mean post-operative levels of Hb were 9.64±1.12 mg/dl and 10.24±1.11 mg/dl with general and spinal anesthesia, respectively. Moreover, the post-operative levels of Hct were 29.83±3.21% and 32.45±3.05% with the spinal and general anesthesia, respectively (P=0.009 and P<0.001). The mean systolic and diastolic blood pressure was significantly higher in the patients in the general anesthesia group than those in the spinal anesthesia group.
Conclusion: The decrease in the post-operative levels of Hb and Hct in the patients who underwent general anesthesia was greater than those who underwent spinal anesthesia.


  1. Naghibi K, Saryazdi H, Kashefi P, Rohani F. The comparison of spinal anesthesia with general anesthesia on the postoperative pain scores and analgesic requirements after elective lower abdominal surgery: a randomized, double-blinded study. J Res Med Sci 2013; 18(7):543-8.
  2. Armendáriz-Buil I, Marenco-Arellano V. Radical hysterectomy in a patient with Steinert disease: spinal anaesthesia, ketamine and TAP and rectus sheath blocks. An Sist Sanit Navar 2015; 38(3):471-4.
  3. Raghvendra KP, Thapa D, Mitra S, Ahuja V, Gombar S, Huria A. Postoperative pain relief following hysterectomy: A randomized controlled trial. J Midlife Health 2016; 7(2):65-8.
  4. Ge DJ, Qi B, Tang G, Li JY. Intraoperative dexmedetomidine promotes postoperative analgesia and recovery in patients after abdominal hysterectomy: a double-blind, randomized clinical trial. Sci Rep 2016; 6:21514.
  5. Castro-Alves LJ, de Medeiros AC, Neves SP, de Albuquerque CL, Modolo NS, De Azevedo VL, et al. Perioperative duloxetine to improve postoperative recovery after abdominal hysterectomy: a prospective, randomized, double-blinded, placebo-controlled study. Anesth Analg 2016; 122(1):98-104.
  6. Amri Maleh P, Alijanpour E, Nickbakhsh N, Modarress R, Naghshineh A, Esmaeili M. Effects of gabapentin on postoperative pain following laparoscopic cholecystectomy. J Mazandaran Univ Med Sci 3013; 23(103):28-31. (Persian).
  7. Ahmadi A, Amri P, Shokri J, Hajian K. Comparison of the analgesic effect of intravenous paracetamol/midazolam and fentanyl in preparation of patients for colonoscopy: a double blind randomized clinical trial. Caspian J Intern Med 2015; 6(2):87-92.
  8. Novin Nikbakhsh PA, Shakeri A, Shakeri A. Change in blood pressure and heart rhythm during transhiatal esophagectomy. Caspian J Intern Med 2012; 3(4):541-5.
  9. Bahrami M, Amri P, Shokri J, Alereza H, Bijani A. Sedative and analgesic effects of propofol-fentanyl versus propofol-ketamine during endoscopic retrograde cholangio-pancreatography: a double-blind randomized clinical trial. Anesth Pain Med 2016; 6(5):e39835.
  10. Singh RK, Saini AM, Goel N, Bisht D, Seth A. Major laparoscopic surgery under regional anesthesia: A rospective feasibility study. Med J Armed Forces India 2015; 71(2):126-31.
  11. Amri P, Reza-Hashemian SM, Sharifi G, Asgari AA. Intrathecal administration of digoxin in rabbits. Anesth Analg 2007; 104(2):469.
  12. Naithani U, Meena MS, Gupta S, Meena K, Swain L, Pradeep DS. Dose-dependent effect of intrathecal dexmedetomidine on isobaric ropivacaine in spinal anesthesia for abdominal hysterectomy: effect on block characteristics and hemodynamics. J Anaesthesiol Clin Pharmacol 2015; 31(1):72-9.
  13. Bagherpour A, Amri Maleh P, Saghebi R. Accidental intrathecal administration of digoxin. Anesth Analg 2006; 103(2):502-3.
  14. Hojjat M, Amri P, Barat S, Bijani A, Amri V. Comparison effect of general and spinal anesthesia on hemoglobin and hematocrit values in women after cesarean section. J Ardabil Univ Med Sci 2016; 15(4):432-40. (Persian).
  15. Kahraman F, Eroglu A. The effect of intravenous magnesium sulfate infusion on sensory spinal block and postoperative pain score in abdominal hysterectomy. Biomed Res Int 2014; 2014:236024.
  16. Dexter F, Aker J, Wright WA. Development of a measure of patient satisfaction with monitored anesthesia care: the Iowa Satisfaction with Anesthesia Scale. Anesthesiology 1997; 87(4):865-73.
  17. Herrera FJ, Wong J, Chung F. A systematic review of postoperative recovery outcomes measurements after ambulatory surgery. Anesth Analg 2007; 105(1):63-9.
  18. Modig J. Regional anaesthesia and blood loss. Acta Anaesthesiol Scand Suppl 1988; 89:44-8.
  19. Imbelloni LE, Fornasari M, Fialho JC, Sant’Anna R, Cordeiro JA. General anesthesia versus spinal anesthesia for laparoscopic cholecystectomy. Rev Bras Anestesiol 2010; 60(3):217-27.
  20. Kessous R, Weintraub AY, Wiznitzer A, Ziotnik A, Pariente G, Polachek H, et al. Spinal versus general anesthesia in cesarean section: the effects on postoperative pain perception. Arch Gynecol Obstet 2012; 286:75-9.
  21. Aksoy H, Aksoy Ü, Yücel B, Özyurt SS, Açmaz G, Babayiğit MA, et al. Blood loss in elective cesarean section: is there a difference related to the type of anesthesia? A randomized prospective study. J Turk Ger Gynecol Assoc 2015; 16(3):158-63.
  22. Movasseghi G, Hassani V, Mohaghegh MR, Safaeian R, Safari S, Zamani MM, et al. Comparison between spinal and general anesthesia in percutaneous nephrolithotomy. Anesth Pain Med 2013; 4(1):e13871.
  23. Bakri M1, Ismail EA, Ghanem G, Shokry M. Spinal versus general anesthesia for Cesarean section in patients with sickle cell anemia. Korean J Anesthesiol 2015; 68(5):469-75.
  24. Martin TC, Bell P, Ogunbiyi O. Comparison of general anaesthesia and spinal anaesthesia for Caesarean section in Antigua and Barbuda. West Indian Med J 2007; 56:330-3.
  25. Kim JE, Lee JH, Kim EJ, Min MW, Ban JS, Lee SG. The effect of type of anesthesia on intra-and postoperative blood loss at elective cesarean section. Korean J Anesthesiol 2012; 62(2):125-9.

Zamani M, Mansour GM, Hajian P, Nasrollahi S. Comparison of hemoglobin concentration, after cesarean section, between two methods: general anesthesia and spinal anesthesia. Iran J Obstet Gynecol Infertil 2008; 11(2):41-8. (Persian)