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Pain is one of the important factors leading to stress. Reasonable perioperative pain management is conducive to reducing stress caused by surgery, reducing the occurrence of adverse events caused by pain, accelerating postoperative recovery, shortening hospitalization time and reducing medical costs, which is one of the important contents emphasized by the concept of enhanced recovery after surgery (ERAS). As a kind of regional nerve block, transverse abdominis plane block (TAPB) is widely used in abdominal pain management due to its simple operation, high success rate and reliable analgesic effect, thus playing an important role in the process of ERAS. The article reviews the anatomical basis, clinical application, influencing factors and limitations of TAPB in order to provide references for the optimization of perioperative pain management in patients with abdominal tumors.
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PURPOSE: This study examined the effects of horse riding simulator exercise on the thickness changes in the transverse abdominis in normal adults. METHODS: Forty-five healthy adults were recruited and randomized to a horseback riding simulation exercise group (n=15), a sling exercise group (n=15), and a trunk stabilization exercise group (n=15). A horseback riding simulator offers the indoor experience of horseback riding and mimics the rhythmic movement of horseback riding, thereby provided a virtual environment, such as riding a real horse on the front screen. The velocity of the horse riding simulator exercise was regulated within the subject's ability to control the exercise on the horse riding simulator. A sling exercise group performed sling exercise under the inspection of the experimenter. In the trunk stabilization exercise group, the subjects were instructed to perform the exercise accurately and pause the session when pain occurred during the intervention. The subjects in each group carried out the interventions three times per week for six weeks. The thickness of the transverse abdominis was measured using a pressure biofeedback unit and the ultrasound. RESULTS: Significant differences in the thickness of transverse abdominis within the groups were observed between before and after the interventions. On the other hand, there were no differences in the parameters among the groups. CONCLUSION: Horse riding simulator exercise can be an alternative to trunk stabilization exercise by increasing the thickness of the transverse abdominis in healthy adults.
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Adulto , Humanos , Biorretroalimentação Psicológica , Mãos , Cavalos , UltrassonografiaRESUMO
Objective • To evaluate the effect of ropivacaine combined with dexmedetomidine on transverse abdominis plane (TAP) block guided by ultrasound and postoperative analgesia. Methods • A total of 180 patients (ASA grade I - II) undergoing laparoscopic ovarian cystectomy were randomly divided into control group (Con group) and dexmedetomidine group (Dex group). At the end of the operations, the patients were sent to the recovery rooms. After 10 minutes, TAP block was performed under the guidance of ultrasound, and morphine intravenous self-controlled analgesia pump was given for postoperative analgesia. The patients in Con group received TAP block with 40 mL of 0.375% ropivacaine. The patients in Dex group received 40 mL of 0.375% ropivacaine containing 100 μg dexmedetomidine. The onset time, duration of the sensory nerve block, delay of the first press of morphine pump, and total amount of morphine within 48 h after the operation and hemodynamic parameters were recorded. Results • The onset time in Dex group was earlier than that in Con group (P=0.032), and the duration of analgesia effect was also longer (P=0.012). The delay of first morphine pump press was also significantly later than that in Con group (P=0.008), and total morphine consumption significantly reduced within 48 h after operation (P=0.001). In terms of heart rate and mean arterial pressure, they were all lower in Dex group than those in Con group. Conclusion • Ropivacaine combined with dexmedetomidine can be safely and effectively used in TAP block. Compared with ropivacaine alone, the combination can maintain a longer sensory block, which can significantly reduce postoperative opioid usage.
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Objective The choice of perioperative analgesia regimens for radical resection of colorectal cancer is still controversial. The purpose of this study was to compare the effects of general anesthesia combined with epidural block or transverse abdominis plane block on surgical recovery of patients, and provide a basis for the choice of analgesic methods for radical resection of colorectal cancer. Methods The clinical data of 118 patients who underwent laparoscopic radical resection of colorectal cancer under general anesthesia in Affiliated Hospital of Nantong University between February 2016 and May 2018 were retrospectively analyzed, and the patients were divided into group A (epidural block, n=61) and group B (transverse abdominis plane block, n=57) according to anesthesia regimens. The two groups were given the same general anesthesia induction and maintenance medication. The dosages of general anesthetics in two groups were recorded, and the postoperative recovery situations (including first anal exhaust time, eating time, ambulation time, hospital stay and visual analogue scale score) were compared, and the stress indexes of heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO2), cortisol (Cor) and norepinephrine (NE)], immune indexes of CD4+, CD8+, CD4+/CD8+, total T lymphocyte count and natural killer cell (NK) count and inflammation indicators of human chemokine CXC ligand 8 (CXCL8), interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) were detected in two groups at different time points. Results The dosage of sufentanil in group A was lower than that in group B [(25.36±4.74) μg vs (28.43±3.69) μg] (P<0.001). The first anal exhaust time, eating time and first ambulation time in group A were shorter than those in group B (P<0.05). The VAS scores in group A were lower than those in group B at different time points (P<0.001). The levels of HR, MAP, Cor and NE in group A were lower than those in group B at T2~T3, and the SpO2 at T2 was lower than that in group B [(5.11±0.31)% vs (5.96±0.34)%] (P<0.05). At 24h after operation, the CD8+ and total T cell in group A were lower than those in group B [(20.79±13.02)% vs (26.91±10.22)%, (60.23±8.97)% vs (64.33±12.76)%] while the CD4+/CD8+ and NK cell count were higher than those in group B [(1.66±0.63) vs (1.25±0.95), (27.71±10.98)% vs (20.02±1.74) %] (P<0.05). The levels of CXCL8, IL-6 and TNF-α were lower than those in group B (P<0.05). There was no significant difference in the incidence rate of adverse reactions between group A and group B (3.28% vs 5.26%) (P>0.05). Conclusion General anesthesia combined with epidural block can reduce the dosages of anesthetic drugs in radical resection of colorectal cancer, reduce the body stress response and inflammatory response, and weaken the early immunosuppressive effects, and its overall analgesic effects are better than those of combined transverse abdominis plane block.
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Antecedentes: numerosas técnicas han sido descriptas para el tratamiento de defectos complejos de la pared abdominal. La técnica de separación de componentes con liberación del músculo transverso (TAR) permite la movilización de colgajos miofasciocutáneos y cierre de la línea media, con baja tasa de complicaciones. Objetivo: evaluar los resultados del tratamiento de eventraciones complejas con técnica TAR. Material y métodos: se incluyó una serie de pacientes en los que se realizó TAR entre marzo de 2013 y abril de 2017, con seguimiento mínimo de 6 meses. Se analizaron variables demográficas y clínicoquirúrgicas. Los resultados fueron expresados en medianas. Resultados: se realizaron 14 eventroplastias con técnica TAR. Diez (70%) correspondieron a hombres. La edad fue 60 (35-81) años y el IMC fue: 28,2 kg/m². El 70% tenía al menos dos cirugías previas. Se solicitó tomografía computarizada preoperatoria en todos los pacientes. El índice de Tanaka fue 24,5%. En 7 (50%) pacientes el riesgo quirúrgico fue ASA < III. El tamaño del defecto fue 480 (224-720) cm² y el de la malla 900 (500-1050) cm². El tiempo operatorio fue 248 (180-341) minutos, y la estadía hospitalaria, 3 (2-4) días. Dos pacientes tuvieron infección del sitio quirúrgico. El seguimiento posoperatorio fue de 20 (6-48) meses, y no se detectaron recidivas. Conclusión: la técnica TAR es un método seguro y fiable para la reparación de grandes defectos de la pared abdominal con baja morbimortalidad y recidiva, por lo que debería considerarse dentro del armamentario quirúrgico.
Background: several strategies have been described for the treatment of complex abdominal wall defects. The component separation technique with transversus abdominis muscle release (TAR) allows adequate fasciomiocutaneos flaps mobilization to close the middle line and has low morbidity. Objective: to evaluate outcomes of TAR technique for the treatment of large incisional hernias. Material and methods: in the period between March 2013 and April 2017, all consecutive patients with TAR procedures with a minimum follow-up of 6 months were included. Demographics, operative and postoperative variables were analyzed. Results were expressed in medians. Results: a total of 14 TAR procedures were performed. Ten patients were men. The age was 60 (35-81) years and BMI was 28,2 kg/m². Seventy percent of the patients had at least two previous surgeries. CT scan was performed before surgery in all patients. Tanaka index was 24,5%. Seven patients had ASA < III. The defect size was 480 (224-720) cm² and mesh size 900 (500 - 1050) cm². Operative time was 248 (180 -341) minutes and hospital stay 3 (2-4) days. Two patients had surgical site infection. Postoperative follow-up was 20 (6-44) months. There was no recurrences. Conclusion: TAR technique is safe and reliable for the repair of large abdominal wall defects with low morbidity and recurrence rates. Therefore it should be taken into account in the surgical armamentarium.
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Humanos , Hérnia Incisional , Músculos Abdominais , Parede AbdominalRESUMO
Introduction: Pain is one of the most important factors that is responsible for many adverse outcomes during surgery and in postoperative period. Effective pain control can also facilitate rehabilitation and accelerate recovery from surgery. Aim: To compare ultrasound-guided TAP block versus patients receiving no Transverse abdominis plane (TAP) block as regards the degree of pain relief in patients undergoing laparoscopic appendectomy. Materials and methods: Prospective single blinded randomized control study. Patients were randomly allocated (computer coded sealed envelopes) to receive either TAP block or no TAP block with regular analgesia. Patient will be observed for 24 hours post operatively. 60 patients divided equally into 2 groups cases were TAP (transverse abdominis plane block) group (n =30), Control group (n= 30). Results: The age between the two groups was analysed using student-t-test , the average age group in control group was found to be 32.64 years and TAP group 29.4 years. There was no significant difference in age between the two groups. The percentage of Males in TAP group was more when compare with Control, whereas in Control group the females were more but the difference was not PSV Rama Rao, M. Vijayakanth, Mohammad Feroz. A prospective single blinded randomized study to assess post operative analgesia using ultrasound guided transverse abdominis plane block for laparoscopic appendectomy. IAIM, 2016; 3(11): 103-111. Page 104 statistically differ. Pain score between two groups was analysed using Maan-Whintney U test. The pvalues of the Mann-Whitney U-test for the 2nd, 6th and 12th hours showed significant (p value – 0.000), which revealed that the mean rank for the pain scores of Control group was significant greater than the TAP group. Whereas for the 24th hour the mean rank for the pain score for both the groups were almost similar. Conclusions: Ultrasound guided TAP block with 0.375% ropivacaine bilaterally can be used effectively for post operative analgesia for patients undergoing laparoscopic appendectomy.
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OBJECTIVE: To investigate changes in lumbar multifidus (LM) and deep lumbar stabilizing abdominal muscles (transverse abdominis [TrA] and obliquus internus [OI]) during transcutaneous neuromuscular electrical stimulation (NMES) of lumbar paraspinal L4-L5 regions using real-time ultrasound imaging (RUSI). METHODS: Lumbar paraspinal regions of 20 healthy physically active male volunteers were stimulated at 20, 50, and 80 Hz. Ultrasound images of the LM, TrA, OI, and obliquus externus (OE) were captured during stimulation at each frequency. RESULTS: The thicknesses of superficial LM and deep LM as measured by RUSI were greater during NMES than at rest for all three frequencies (p<0.05). The thicknesses in TrA, OI, and OE were also significantly greater during NMES of lumbar paraspinal regions than at rest (p<0.05). CONCLUSION: The studied transcutaneous NMES of the lumbar paraspinal region significantly activated deep spinal stabilizing muscle (LM) and the abdominal lumbar stabilizing muscles TrA and OI as evidenced by RUSI. The findings of this study suggested that transcutaneous NMES might be useful for improving spinal stability and strength in patients having difficulty initiating contraction of these muscles.
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Humanos , Masculino , Músculos Abdominais , Estimulação Elétrica , Músculos , Músculos Paraespinais , Ultrassonografia , VoluntáriosRESUMO
BACKGROUND: The ultrasound-guided transverse abdominis plane block (TAPB) reduces postoperative pain after laparoscopic abdominal surgery. But, its effect post laparoscopic totally extraperitoneal hernia repair (TEP) is not clear. In this study, we evaluated the analgesic effect of ultrasound-guided TAPB in TEP. METHODS: In this prospective, randomized study, forty adult patients (ASA I-II) scheduled for a TEP under general anesthesia were studied. In the TAPB group (n = 20), an ultrasound-guided bilateral TAPB was performed with 0.375% ropivacaine 15 ml on each side after the induction of general anesthesia. The control group (n = 20) did not have TAPB performed. Fentanyl 50 microg was repeatedly injected as per the patient's request in the recovery room. Pain scores at rest and on coughing were assessed postoperatively in the recovery room (20 min, at discharge) and at 4, 8, and 24 hours after surgery. RESULTS: In the recovery room, pain scores (numeric rating scale, 0-10) at postoperative 20 min were lower in the TAPB group (3.9 +/- 1.6, 4.9 +/- 1.8) than the control group (6.9 +/- 1.6, 8.0 +/- 1.6) at rest and on coughing. Also, pain scores upon discharge from the recovery room were lower in the TAPB group (3.2 +/- 1.2, 4.2 +/- 1.5) than the control group (5.3 +/- 1.6, 6.5 +/- 1.8) at rest and on coughing. CONCLUSIONS: The ultrasound-guided TAPB in patients that had undergone TEP reduced postoperative pain scores and the fentanyl requirement in the recovery room. Also, pain scores on coughing were reduced until postoperative 8 hours.
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Adulto , Humanos , Amidas , Anestesia Geral , Benzamidinas , Tosse , Fentanila , Hérnia , Herniorrafia , Laparoscopia , Dor Pós-Operatória , Estudos Prospectivos , Pirazinas , Sala de RecuperaçãoRESUMO
BACKGROUND: Several methods are performed to control the pain after a laparoscopic cholecystectomy. Recently, the transverse abdominis plane block has been proposed to compensate for the problems developed by preexisting methods. This study was designed to evaluate the effect of the ultrasound-guided transverse abdominis plane block (US-TAP block) and compare efficacy according to the concentration of local analgesics in patients undergoing laparoscopic cholecystectomy. METHODS: Fifty-four patients undergoing laparoscopic cholecystectomy were randomized into three groups. The patients in Group Control did not receive the US-TAP block. The patients in Group B(0.25) and Group B(0.5) received the US-TAP block with 0.25% and 0.5% levobupivacaine 30 ml respectively. After the general anesthesia, a bilateral US-TAP block was performed using an in-plane technique with 15 ml levobupivacaine on each side. Intraoperative use of remifentanil and postoperative demand of rescue analgesics in PACU were recorded. The postoperative verbal numerical rating scale (VNRS) was evaluated at 20, 30, and 60 min, and 6, 12, and 24 hr. Postoperative complications, including pneumoperitoneum, bleeding, infection, and sleep disturbance, were also checked. RESULTS: The intraoperative use of remifentanil, postoperative VNRS and the postoperative demand of rescue analgesics were lower in the groups receiving the US-TAP block (Group B(0.25) and Group B(0.5)) than Group Control. There were no statistically or clinically significant differences between Group B(0.25) and Group B(0.5). No complications related to the US-TAP block were observed. CONCLUSIONS: The US-TAP block with 0.25% or 0.5% levobupivacaine 30 ml (15 ml on each side) significantly reduced postoperative pain in patients undergoing laparoscopic cholecystectomy.