Abstract
BackgroundPatients undergoing craniotomy operations are prone to various noxious stimuli, many strategies are commenced to provide state of analgesia, for better control of the stress response and to overcome its undesired effects on the haemodynamics and post-operative pain. Scalp nerves block are considered one of these strategies. This study was conceived to evaluate the effect of addition of hyaluronidase to the local anaesthetic mixture used in the scalp nerves block in patients undergoing elective craniotomy operations.Methods64 patients undergoing elective craniotomy operations were enrolled in this prospective randomized, double-blind comparative study. Patients were randomly assigned to two groups. Group LA, patients subjected to scalp nerves block with 15 ml bupivacaine 0.5%, 15 ml lidocaine 2%, in 1:400000 epinephrine. Group H as Group LA with15 IU /ml Hyaluronidase.ResultsPatients in the H group showed lower VAS values for 8 h postoperative, compared to the LA group. The haemodynamic response showed lower values in the H group, compared to the LA group. Those effects were shown in the intraoperative period and for 6 h post-operative. No difference was detected regarding the incidence of complications nor the safety profile.ConclusionOur data supports the idea that addition of hyaluronidase to the local anesthetic mixture improves the success rates of the scalp nerves block and its efficacy especially during stressful intraoperative periods and in the early postoperative period. No evident undesirable effects in relation to the addition of hyaluronidase.Trial registrationClinical Trial registry on ClinicalTrials.gov, NCT 03411330, 25-1-2018.
Highlights
Patients undergoing craniotomy operations are prone to various noxious stimuli, many strategies are commenced to provide state of analgesia, for better control of the stress response and to overcome its undesired effects on the haemodynamics and post-operative pain
Blocking the scalp nerves using 0.5% bupivacaine combined with lidocaine 2%is readily used to decrease hemodynamic response during and after craniotomy operations [5, 6]
There were significant statistical differences between the 2 groups, where the Visual Analogue Scale (VAS) for pain was lower in the hyaluronidase group immediately post-operative, after 2, 4, 6 and 8 h post operatively
Summary
Patients undergoing craniotomy operations are prone to various noxious stimuli, many strategies are commenced to provide state of analgesia, for better control of the stress response and to overcome its undesired effects on the haemodynamics and post-operative pain. This study was conceived to evaluate the effect of addition of hyaluronidase to the local anaesthetic mixture used in the scalp nerves block in patients undergoing elective craniotomy operations. Strategies to blunt and attenuate the stress response to these noxious stimuli include administration of systemic opioids, deepening the level of anaesthesia and scalp nerve blocks [1, 2]. The stress response is the hormonal and metabolic changes that follow injury or trauma. This includes wide range of endocrinal and immunological effects. Blocking the scalp nerves using 0.5% bupivacaine combined with lidocaine 2%is readily used to decrease hemodynamic response during and after craniotomy operations [5, 6]
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