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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.

The sporicidal activity of a 1% solution of five local anaesthetics and five preservatives (cetrimide, chlorocresol, chlorhexidine, phenoxyethanol and phenylmercuric nitrate) at their commonly used concentrations, alone and in binary combinations, was determined against Bacillus subtilis and Aspergillus niger spores at different temperature levels by surface viable count technique. The sporicidal activity of all tested systems was temperature dependent and A. niger spores were much more sensitive to the effect of the test systems than B. subtilis spores. The temperatures at which 99% kill is achieved after 30 min exposure were calculated. For local anaesthetics used singly against A. niger the recorded temperatures were 30 degrees C for amethocaine, 45 degrees C for amylocaine, 43 degrees C for cincochaine, 48 degrees C and 50 degrees C for lignocaine and procaine, respectively. A control temperature of 58 degrees C for saline solution was observed. Much higher temperatures were recorded for B. subtilis spores. Cincochaine was the most effective local anaesthetic with a recorded temperature of 60 degrees C for a 99% kill while amylocaine and amethocaine showed temperatures of 84 and 90 degrees C respectively. Procaine, lignocaine as well as the control saline solution recorded temperatures higher than 100 degrees C. Among the 25 binary combinations of local anaesthetics and preservatives tested, the most pronounced potentiation of the sporicidal activity against fungal spores was recorded with chlorocresol combinations, while other combinations of the four remaining preservatives showed different types of interactions at various temperature levels.

The sporicidal activity of 1% solutions of five local anaesthetics and five preservatives (cetrimide, chlorocresol, chlorhexidine, phenoxyethanol and phenylmercuric nitrate) at their pharmacopeial concentrations, alone and in binary combinations was determined against Bacillus subtilis and Aspergillus niger spores at different temperature levels by the surface viable count technique. The sporicidal activity of all tested systems were temperature dependent. A. niger spores were much more sensitive to the tested systems than B. subtilis spores. The temperature at which 99% of all spores were killed after 30 min exposure time of the anaesthetics were calculated. In case of the local anaesthetics alone against spores of A. niger the recorded temperatures were 30 degrees C for amethocaine, 45 degrees C for both amylocaine and cincochaine, 48 degrees C and 50 degrees C for lignocaine and procaine, respectively, in contrast to 58 degrees C in a control with saline solution. Much higher temperatures were calculated against B. subtilis spores. Cincochaine was the most effective local anaesthetic with a recorded temperature of 60 degrees C, where 99% killing occurred. Amylocaine and amethocaine showed temperatures of 84 degrees C and 90 degrees C, respectively. Procaine, lignocaine as well saline solution as a control caused a 99% killing effect at temperatures higher than 100 degrees C. Among the 25 tested binary combinations of local anaesthetics and preservatives, the highest incidence of potentiation of the sporicidal activity was recorded with chlorocresol combinations, while other combinations of the four remaining preservatives showed different types of interactions at different percentages.