Background: Neuromodulation alters nerve activity by implanted electrodes that provide regulated electrical pulses, with adjustable parameters including the width, frequency, and amplitude of the pulse.Aim: To evaluate the efficacy and safety of caudal epidural analgesia compared to peripheral nerve stimulation for alleviation of pain and paresthesia.Patients and Method: A clinical therapeutic interventional trial study was undertaken between January and December 2024. The study registered 80 patients who were diagnosed with dibatic peripheral neuropathy were enrolled in the current study. Those patients were categorized into two groups: Group A comprised 40 patients receiving caudal epidural stimulation treatment; Group B comprised 40 patients receiving peripheral nerve stimulation treatment.Results: In both groups, there was a significant number of patients who got sensory improvement after intervention. In both groups, there was significant pain improvement as revealed by the visual analogue scale (P-values were 0.001 for both). After the second session, the patients in group A had a significantly higher improvement in sensation (P-value=0.023), paresthesia (P-value=0.033), and pain (P-value=0.007) than patients in group B.Conclusion: Both caudal epidural nerve stimulation and peripheral nerve stimulation are safe and active approaches in the treatment of peripheral neuropathy but caudal epidural nerve stimulation is more effective regarding sensory sensation, paresthesia, and pain sensation than peripheral nerve stimulation.

Background Thoracic trauma is a leading cause of morbidity and mortality, second only to head injuries in trauma-related deaths. Blunt injuries, particularly from road traffic accidents (RTAs), are more frequent than penetrating injuries, yet regional epidemiological data remain limited. Objective To evaluate the prevalence, etiology, complications, and management of chest trauma among patients admitted to Shar Teaching Hospital (STH), Sulaimani, Kurdistan Region, Iraq. Methods This cross-sectional study included 152 consecutive chest trauma patients admitted between January and December 2024. Data on demographics, trauma type, etiology, complications, and management were collected using a structured questionnaire. Clinical evaluation included radiological and laboratory investigations, primary and secondary surveys, and emergency protocols. Data were analyzed using SPSS Version 26. Results Males predominated (male-to-female ratio 4.6:1), with a mean age of 34.9 years (range 4–87); young adults (19–30 years) represented 30.9% of cases. RTAs were the most common cause (45%), followed by stab injuries (24%) and falls from height (23%). Blunt trauma accounted for 71.1%, commonly resulting in rib fractures, lung contusions, pneumothorax, and hemothorax. Penetrating trauma comprised 28.9%, most often complicated by hemothorax or hemopneumothorax. Management was conservative in 51.3%, chest tube insertion in 42.8%, and surgical intervention in 5.9% of cases. Conclusion Chest trauma at STH predominantly affects young adult males, with RTAs as the leading cause. Blunt trauma is more frequent, and most patients respond well to non-operative management or tube thoracostomy. Surgical intervention is reserved for severe cases. These findings emphasize the importance of rapid diagnosis, timely intervention, and preventive strategies to reduce trauma-related morbidity and mortality.

Treatment of postoperative pain is one of the concerns of all anesthesiologist since inguinal hernia repair surgery is more done as day case surgery so treatment of postoperative pain is crucial since can reduce hospital stay, improve mobilization and patient satisfaction. Transvers abdomens plane block and ilioiguinal ,iliohypogastric nerves block are two different methods by ultrasound guide required anesthesia used to treat postoperative pain.

Background: Pulsed radiofrequency is an interventional pain management technique that has been successful in treating radicular pain brought on by nerve damage, trigeminal neuralgia, and thoracic postherpetic neuralgia.Aim: To evaluate the effectiveness and safety of peripheral nerve stimulation combined with pulse radiofrequency in the management of brachial plexus injury.Patients and method: A clinical therapeutic trial was carried out in Baghdad, Iraq, between the first of April to the first of October 2024. A convenient sample of 50 patients aged 18 years or older with brachial plexus injury was included in the present study. The intervention was done in two sessions at three months intervals and included nerve stimulation, including sensory and motor stimulation, followed by pulse radiofrequency at the same time for the brachial plexus roots.Results: The proportion of patients experiencing sensory impairment significantly declined after the first session (P-value = 0.001) and showed a further significant reduction following the second session compared to the first. According to the electromyography assessment and clinical examination, the proportion of patients with severe motor injury significantly decreased after the first session (P-value<0.01). Then, it significantly decreased after the second session compared to the first session (P-value<0.01). In addition, 32 (64.0%) patients had functional recovery after the second session. An improvement was obtained in the pain after the first session and after the second session compared to the first session (P-value=0.001 for both).Conclusion: Pulsed radiofrequency combined with nerve stimulation offers an effective and safe approach to treating functional disabilities caused by peripheral nerve injuries, including injuries to the brachial plexus. These methods are also effective for managing pain associated with such injuries.Keywords: Pulsed radiofrequency, nerve stimulation, brachial plexus injury

Bleeding into the surgical field is a major issue faced by endoscopic surgeons particularly if it is performed in narrow confines of the nasal cavity. Objective: To determine whether infiltration of a mixture of lidocaine: adrenaline into pterygopalatine fossa has an effect on intraoperative field bleeding during endoscopic nasal surgery. Methods: A prospective, double blinded study was undertaken to assess 88 patients who had endoscopic nasal surgery indicated for chronic sinusitis with or without nasal polyps and dacryocystorhinostomy. Patients who received injection were selected randomly and the same anaesthetist infiltrated a solution of 2% lidocaine and 1:100,000 adrenaline into pterygopalatine fossa of all patients. All operations were undertaken by the same surgeon who assessed intraoperative bleeding every 15 minutes according to Boezaart and Van der Merwe grading system. Results: The difference in the degrees of bleeding among patients who received versus those who did not receive injection was not statistically significant (p-value = 0.36). Conclusion: According to the dose of treatment and condition applied in these operations, it seems that pterygopalatine fossa injection with lidocaine: adrenaline does not decrease intraoperative bleeding during endoscopic nasal surgery.

Background: Hip fractures are one of the most frequently encountered complaints in both the young and elderly population. USG-guided peripheral nerve blocks help in early surgical fixation by providing perioperative pain relief and early mobilization.Methods: 60 patients of either sex, ASA 1 to 3, aged 18-65, scheduled to undergo surgery for hip fracture, were randomly allocated into two groups. Group P received a USG-guided PENG block, and Group F received an FIC block. Results: In the PENG group, 26(86.7%) patients showed grade 1 positioning, 3(10%) patients showed grade 2, and 1 patient showed grade 3 positioning. In the FICB group,11(36.7%) patients showed grade 1 positioning, 17(56.7%) patients showed grade 2, and 2 patients showed grade 3 positioning. Grade 1 (86.7%) was higher in the PENG group, while grade 2 (56.7%) was higher in the FICB group.Conclusion: PENG block provides better analgesia and better quality of positioning during spinal anaesthesia than FIC block.

Background and Aim: Deliberate hypotension to provide bloodless surgical field gives better visibility of the operative field, with reduced risk of injury to adjoining structures. This present study was conducted to compare three loading doses of dexmedetomidine for controlled hypotension in FESS surgery under GA.Methods: Sixty patients aged between 18-60 years of either sex belonging to American Society of Anesthesiology I and II scheduled for FESS were randomly allocated to one of the three groups. Patients in group I, II and III received dexmedetomidine loading infusion at a rate of 1 μg kg-1, 0.8 μg kg-1 and 0.6 μg kg-1 respectively over 10 minutes followed by continuous infusion of 0.5 μg kg-1 h-1. The primary goal was to provide a MAP in a range of 60 - 70 mmHg before the start of surgery. Results:It was found that Mean HR as well as MAP was significantly lower in group I as compared to group II and III at multiple points. Also, time to achieve MAP was significantly lower in group I. (p < 0.001). surgical field visibility and surgeon satisfaction was better in group I.Conclusion: We concluded that using IV dexmedetomidine as an adjunct to other anesthetics is an acceptable approach to provide controlled hypotension. Administration of a loading dose of 1 µg kg-1 and 0.8 µg kg-1 compared to 0.6 µg kg-1, provides better surgical field conditions in terms of bleeding and visibility.

Background: Pulsed radiofrequency is an interventional pain management technique that has been successful in treating radicular pain brought on by nerve damage, trigeminal neuralgia, and thoracic postherpetic neuralgia.Aim of the study: To examine both the therapeutic benefits and potential risks of pulse radiofrequency in the management of pain and paresthesia in patients with diabetes mellitus.Patients and method: A clinical therapeutic trial study was done in Baghdad, Iraq between April 1 and October 1, 2024. A convenient sample of 80 patients who had diabetic neuropathy were enrolled.  The intervention included pulse radiofrequency for two sessions at three months intervals.Results: The proportion of patients with severe paresthesia significantly decreased after the first session (P-value=0.006). Then, it significantly decreased after the second session compared to the first session (P-value=0.029). There was an improvement in the pain as estimated by the VAS score after the first session and after the second session compared to the first session (P-value= were 0.003 and 0.004, respectively).Conclusion: About 50–70% of the patients had pain reduction with improved mobility and reduced medication dependence. It is recommended to repeat pulsed radiofrequency if pain returns (every 3–6 months if needed).

Introduction of anti-VEGF therapy has revive the way of management to the retinal diseases .Pegaptanib (macugen)was the first to be approved and was followed by other agents ,including ranibizumab(Lucentis,Genentech,San Francisco,Calif.) ,bevacizumab (Avastin,Genentech) and aflibercept (Eylea,Regeneron,Tarrytown,N.Y.)Studies have shown the safety and efficacy of these agents in the treatment of wet ARMD ,RVO and DME .These drugs delivered into the vitreous cavity through pars plana injection ,and are generally safe with little serious complications. Aim :To evaluate the rate of microbial contamination and safety aspects of multi puncture vials of bevacizumab(Avastin) and to determine the rate of endophthalmitis in patients who received intravitreal injections .Methods :A multi-centric prospective study conducted at the Basrah general teaching hospital and Al-zubair general hospital , Basrah ,Iraq, a total of of 28 consecutive vials of bevacizumab {Avastin;F.Hoffmann-LaRoche Ltd.Switzerland}were used .A total 1096 injections were administered to 899 patients between sept. 2019 and Nov. 2024.After puncture the vial ,multidoses used for intravitreal injections , residue bevacizumab in the vial was stored in the refrigerator at 2-8c and reused for up to 4 weeks .From each vial, sample of 0.05was withdrawn with the sterile 1ml syringe under aseptic technique at week 1,2,3 and 4th after opening the vial.These samples were sent for bacterial gram staining and culture .Patients who received the injections were given topical antibiotic eye drops and monitored for the signs and symptoms of inflammation or endophthalmitis for 6 weeks.Results: No evidence of microbial contamination was detected in 28 vials as approved by the results of microbial staining and culture.One patient of 899 patients who received intravitreal injections from these vials showed signs of inflammation,otherwise; no evidence of endophthalmits.Conclusion: Use multidoses Avastin vial after opening is safe.

Background: Tracheal intubation remains a cornerstone of airway management. Nasotracheal intubation (NTI) offers specific advantages, including reduced need for neck extension, making it particularly useful in patients with cervical spine instability or limited mouth opening. To guide the endotracheal tube (ETT) into the trachea, Magill forceps or gradual cuff inflation may be used. While Magill forceps are effective, they carry risks of mucosal trauma and cuff damage and require adequate mouth opening.Objective: To compare the performance of video-assisted NTI using Magill forceps versus the cuff inflation technique in terms of intubation time, number of attempts, and complicationsMethods: This prospective, randomized study was conducted in the intensive care unit of a tertiary hospital. Fifty adult patients requiring NTI were allocated into two equal groups (n=25): one undergoing intubation with Magill forceps, the other using the cuff inflation technique. All procedures were performed under VL guidance.Results: Smooth intubation was achieved in 64% of the Magill group and 48% of the cuff inflation group. Absolute failure occurred in one Magill case and two inflation cases. Bleeding occurred equally in both groups (12%). A second intubation attempt was required in 24% of the Magill group and 32% of the cuff inflation group. Cuff damage occurred in three cases in the Magill group but was not observed in the inflation group. No statistically significant differences were found between groups in primary outcomes (p > 0.05). One patient experienced transient hypoxemia (SpO₂ <92%) and was managed with oral intubation. No serious complications were recorded.Conclusion: Both techniques are feasible and safe when combined. The cuff inflation method offers advantages in patients with limited mouth opening and reduces the risk of ETT cuff damage. However, tip misdirection during inflation can occur and may require additional manipulation.