Randomized Controlled Trial

. 2018 Sep 15;18(1):129.

doi: 10.1186/s12871-018-0590-9.

Safety and efficacy of addition of hyaluronidase to a mixture of lidocaine and bupivacaine in scalp nerves block in elective craniotomy operations; comparative study

Ahmed Abdalla Mohamed¹, Tarek Ahmed Radwan², Mohamed Mahmoud Mohamed³, Hatem Abdellatif Mohamed⁴, Mohamed Farid Mohamed Elemady⁵, Safinaz Hassan Osman⁶, Tamer Fayez Safan⁷, Tamer Mohamed Khair⁸, Norhan Abdelaleem Ali⁹, Rania Samir Fahmy⁷, Mohamed Ibrahim Belita⁷, Shady Rady Abdalla⁷, Ahmed Abdelaziz Seleem¹⁰, Ehab Mohi Atta⁷, Osama Ismail Zaid⁷, Ahmed Shaker Ragab¹¹, Ahmed Essam Salem¹², Badawy Mohamed AlKholy¹³

Affiliations

¹ Anaesthesia, Faculty of Medicine, Cairo University, 139 H,Kafra Gate,Hadayk AL Ahram, Giza, Egypt. ahmed.aboali7268@gmail.com.
² Anaesthesia, Faculty of Medicine, Cairo University, 52 Elthawra street, Heliopolis, Cairo, Egypt.
³ Anaesthesia, Faculty of Medicine, Cairo University, 10 Abdlhameed Kotb Street, Kozzika, Maadi, Cairo, Egypt.
⁴ Anaesthesia, Faculty of Medicine, Cairo University, 6 Ahmed Angad Street, Faisal-Alharam-Giza, Egypt.
⁵ Anaesthesia, Faculty of Medicine, Cairo University, 391 Sudan Street, El Mohandsen, Cairo, Egypt.
⁶ Anaesthesia, Faculty of Medicine, Cairo University, 4 Hussein El Ezaby Street, Misr Alexandria Road, Cairo, Egypt.
⁷ Anaesthesia, Faculty of Medicine, Cairo University, 1 Alsaraya Street, Almanyal, 11559, Cairo, Egypt.
⁸ Anaesthesia, Faculty of Medicine, Cairo University, 290 Teraat el gabal Street, El Zayton, Cairo, Egypt.
⁹ Anaesthesia, Faculty of Medicine, Cairo University, 29 Mansoura street, Agouza, Giza, Egypt.
¹⁰ Anaesthesia, Faculty of Medicine, Cairo University, 15 B, Misr Construction Buldings,Zahraa el Maadi, Cairo, Egypt.
¹¹ Anaesthesia, National Cancer Institute, Anaesthesiology Department, Cairo University, Kasr Alainy Street, Cairo, Egypt.
¹² Anaesthesia, Faculty of Medicine, Tanta University, 92 Ahmed Orabi Street, El Mohandsen, Cairo, Egypt.
¹³ Chemical Patholpgy, Faculty of Medicine, Cairo University, 10 B Youssef Algendy Street, Bab Allouk, Cairo, Egypt.

PMID: 30219027
PMCID: PMC6138934
DOI: 10.1186/s12871-018-0590-9

Randomized Controlled Trial

Safety and efficacy of addition of hyaluronidase to a mixture of lidocaine and bupivacaine in scalp nerves block in elective craniotomy operations; comparative study

Ahmed Abdalla Mohamed et al. BMC Anesthesiol. 2018.

. 2018 Sep 15;18(1):129.

doi: 10.1186/s12871-018-0590-9.

Authors

Affiliations

¹ Anaesthesia, Faculty of Medicine, Cairo University, 139 H,Kafra Gate,Hadayk AL Ahram, Giza, Egypt. ahmed.aboali7268@gmail.com.
² Anaesthesia, Faculty of Medicine, Cairo University, 52 Elthawra street, Heliopolis, Cairo, Egypt.
³ Anaesthesia, Faculty of Medicine, Cairo University, 10 Abdlhameed Kotb Street, Kozzika, Maadi, Cairo, Egypt.
⁴ Anaesthesia, Faculty of Medicine, Cairo University, 6 Ahmed Angad Street, Faisal-Alharam-Giza, Egypt.
⁵ Anaesthesia, Faculty of Medicine, Cairo University, 391 Sudan Street, El Mohandsen, Cairo, Egypt.
⁶ Anaesthesia, Faculty of Medicine, Cairo University, 4 Hussein El Ezaby Street, Misr Alexandria Road, Cairo, Egypt.
⁷ Anaesthesia, Faculty of Medicine, Cairo University, 1 Alsaraya Street, Almanyal, 11559, Cairo, Egypt.
⁸ Anaesthesia, Faculty of Medicine, Cairo University, 290 Teraat el gabal Street, El Zayton, Cairo, Egypt.
⁹ Anaesthesia, Faculty of Medicine, Cairo University, 29 Mansoura street, Agouza, Giza, Egypt.
¹⁰ Anaesthesia, Faculty of Medicine, Cairo University, 15 B, Misr Construction Buldings,Zahraa el Maadi, Cairo, Egypt.
¹¹ Anaesthesia, National Cancer Institute, Anaesthesiology Department, Cairo University, Kasr Alainy Street, Cairo, Egypt.
¹² Anaesthesia, Faculty of Medicine, Tanta University, 92 Ahmed Orabi Street, El Mohandsen, Cairo, Egypt.
¹³ Chemical Patholpgy, Faculty of Medicine, Cairo University, 10 B Youssef Algendy Street, Bab Allouk, Cairo, Egypt.

PMID: 30219027
PMCID: PMC6138934
DOI: 10.1186/s12871-018-0590-9

Abstract

Background: 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. 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.

Methods: 64 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.

Results: Patients 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.

Conclusion: Our 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 registration: Clinical Trial registry on ClinicalTrials.gov , NCT 03411330 , 25-1-2018.

Trial registration: ClinicalTrials.gov NCT03411330.

Keywords: Bupivacaine; Craniotomy; Hyaluronidase; Lidocaine; Scalp block.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval from Cairo university hospitals research committee was obtained (N-58-2017). Approval date:23-12-2017. Written informed consents were obtained from participants before inclusion. Clinical Trial registry on ClinicalTrials.gov ID: NCT 03411330 with Approval date:25-1-2018.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 2**
Comparison between the 2 groups as regards perioperative and intraoperative heart rate (HR). *(H) Meaning for the hyaluronidase group, (LA) Meaning for the local anesthetics only group, Values are represented as mean ± SD,* * Significant P value less than (0.05), comparison between the 2 groups

**Fig. 3**
Comparison between the 2 groups as regards perioperative and intraoperative mean arterial blood pressure (MAP). *(H) Meaning for the hyaluronidase group, (LA) Meaning for the local anesthetics only group, Values are represented as mean ± SD,* * Significant P value less than (0.05), comparison between the 2 groups

**Fig. 4**
Comparison between the 2 groups as regards perioperative and intraoperative Changes in serum IL-6 levels (pgm/ml). *(H) Meaning for the hyaluronidase group, (LA) Meaning for the local anesthetics only group*

See this image and copyright information in PMC

References

1. Dilmen OK, Akcil EF, Tunali Y, Karabulut ES, Bahar M, Altindas F, Vehid H, Yentur E. Postoperative analgesia for supratentorial craniotomy. Clin Neurol Neurosurg. 2016;146:90–95. doi: 10.1016/j.clineuro.2016.04.026. - DOI - PubMed
1. Tuchinda L, Somboonviboon W, Supbornsug K, et al. Bupivacaine scalp nerve block: hemodynamic response during craniotomy, intraoperative and post-operative analgesia. Asian Biomedicine. 2010;4(2):243–251. doi: 10.2478/abm-2010-0031. - DOI
1. Pinosky ML, Fishman RL, Reeves ST, et al. The effect of bupivacaine skull block on the hemodynamic response to craniotomy. Anesth Analg. 1996;83:1256–1261. doi: 10.1213/00000539-199612000-00022. - DOI - PubMed
1. Haldar R, Kaushal A, Gupta D, et al. Pain following craniotomy: reassessment of the available options. Biomed Res Int. 2015;2015:509164. doi: 10.1155/2015/509164. - DOI - PMC - PubMed
1. Hwang JY, Bang JS, Oh CW, et al. Effect of scalp blocks with levobupivacaine on recovery profiles after craniotomy for aneurysm clipping: a randomized, double-blind, and controlled study. World Neurosurg. 2015;83:108–113. doi: 10.1016/j.wneu.2013.05.009. - DOI - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions
Actions
Actions

Associated data

Actions
- Search in PubMed
- Search in ClinicalTrials.gov

LinkOut - more resources

Full Text Sources
Other Literature Sources
- H1 Connect - Access expert opinions and insights on biomedical research.
- scite Smart Citations
Medical
- ClinicalTrials.gov

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Safety and efficacy of addition of hyaluronidase to a mixture of lidocaine and bupivacaine in scalp nerves block in elective craniotomy operations; comparative study

Affiliations

Safety and efficacy of addition of hyaluronidase to a mixture of lidocaine and bupivacaine in scalp nerves block in elective craniotomy operations; comparative study

Authors

Affiliations

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

Figures

References

Publication types

MeSH terms

Substances

Associated data

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical