الفهرس 
Safety and efficacy of addition of hyaluronidase to a mixture of lidocaine and bupivacaine in scalp nerves block in elective craniotomy operations
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Abstract
Patients undergoing craniotomy operations are prone tovarious types of noxious stimuli causing undesirable effects regarding the effects onhemodynamics and subsequent pain control after the operations.⁽¹⁾ Many strategies are recommended to decrease the potential effects of the stress response caused by these stimuli, classically high doses of opioids are used in the majority of the craniotomy operations, however, most systemically administered opioids associated with side effects such as postoperative sedation,with a potential respiratory depression, nausea and vomiting. Using regional aesthetic techniques with general anaesthesia have been conducted as multimodality for better hemodynamic management and controlof post-craniotomy pain.⁽²⁾ Hyaluronidase is an enzyme that degrades the extracellular substance , originally secreted by bacteria to allow their spread, now used for many medical purposes including mixing with local anaesthetics to facilitate diffusion and spread through the various tissue planes, it is reliably used in ophthalmic nerve blocks , hence the idea of using hyaluronidase, being added to local anaesthetics, in the scalp nerves block to enhance the spread of the anaesthetics, allowing them to reach the target nerves in a fast and effective way.⁽³⁾ The surgical stress response includes various hormonal and metabolic changes that follow tissue injury or trauma.⁽⁴ ̕⁵⁾ Theses effects may include changes in the plasma levels of cortisol and interleukin- 6,that may be useful to signify the magnitude of stress and pain related to various types of trauma. ⁽⁶⁾In this study, the effect of hyaluronidase added to local anesthetics in scalp nerves block was evaluated, 64 patients randomly allocated in 2 groups, one group received classic block with local anesthetics only, the other group received block with added hyaluronidase. Intra and postoperative hemodynamics: (HR, SBP, DBP, MAP) were recorded, VAS for pain in the postoperative period, intraoperative rescue analgesia, postoperative first analgesic request, serum cortisol and IL-6.Monitoring the changes of hemoglobin levels as well as complications.The study showed, the added hyaluronidase effectively improved many aspects of the block especially the hemodynamic control intraoperative and analgesic state in the early postoperative period