Ultrasound-guided peripheral abdominal wall blocks

The practice of regional anesthesia is in a state of progressive evolution, mainly due to the advent of ultrasound as an anesthesiologist's instrument. Alternative techniques for postoperative analgesia of abdominal surgeries, such as transversus abdominis plane block, oblique subcostal transversus abdominis plane block, rectus abdominis muscle sheath block, ilioinguinal and iliohypogastric nerve block, and quadratus lumborum plane block, have proven useful, with good analgesic efficacy, especially when neuroaxial techniques (spinal anesthesia or epidural anesthesia) are not possible. This review discusses such blockades in detail, including the anatomical principles, indications, techniques, and potential complications.

Proprioceptive Stabilizer™ training of the abdominal wall muscles in healthy subjects: a quasi-experimental study

SUMMARY The present quasi-experimental study aimed to assess the transversus abdominis (TrA), internal oblique (IO) and external oblique (EO) thickness in healthy subjects with the proprioceptive Stabilizer™ training in abdominal wall muscles. A sample of 41 healthy participants (age: 31.9 ± 4.5 y; height: 1.7 ± 0.1 m; weight: 68.3 ± 13.1 kg; body mass index, BMI: 22.9 ± 2.7 kg/m2) were recruited to participate in this study. Ultrasound images of the EO, IO, TrA, rectus anterior (RA) and interrecti distance (IRD) were measured and analyzed by the ImageJ software. Measurements were made at rest and during the abdominal drawing-maneuver (ADIM) developed by the patients with the Stabilizer™ located in the low back holding 40 mmHg for 10 seconds with a visual stimulus provided by a circular pressure marker. Ultrasound measurements for the abdominal wall muscles showed statistically significant differences (Π < .05) for a thickness decrease of the EO, IO and a thickness increase of TrA. A proprioceptive Stabilizer™ training produced a thickness increase in TrA muscle and a thickness decrease in EO and IO muscles in healthy subjects. These findings suggest that a proprioceptive Stabilizer™ training could be useful in individuals with low back pain and lumbopelvic pain.

RESUMO O objetivo do presente estudo foi avaliar o transverso abdominal (TrA), o oblíquo interno (OI) e a espessura oblíqua externa (EO) em indivíduos saudáveis com o treinamento proprioceptivo Stabilizer™ nos músculos da parede abdominal. Uma amostra de 41 participantes saudáveis (idade: 31,9±4,5 y, altura: 1,7±0,1 m; peso: 68,3±13,1 kg; índice de massa corporal, IMC: 22,9±2,7 kg / m2) foram recrutados para participar deste estudo. As imagens de ultrassom do EO, IO, TrA, reto anterior (RA) e distância interrecti (IRD) foram medidas e analisadas pelo software ImageJ. As medidas foram feitas em repouso e durante a manobra de desenho abdominal (Adim) desenvolvida pelos pacientes com o StabilizerTM localizado na parte inferior das costas segurando 40 mmHg por 10 segundos com um estímulo visual fornecido por um marcador de pressão circular. As medidas de ultrassom para os músculos da parede abdominal apresentaram diferenças estatisticamente significativas (P<0,05) para uma diminuição da espessura do EO, IO e um aumento de espessura do TrA. Um treinamento proprioceptivo Stabilizer™ produziu um aumento de espessura no músculo TrA e uma diminuição da espessura nos músculos EO e IO em indivíduos saudáveis. Esses achados sugerem que um treinamento de Stabilizer™ proprioceptivo poderia ser útil em indivíduos com dor lombar e dor lombo-pélvica.

Ultrasonography features of abdominal perimuscular connective tissue in elite and amateur basketball players: an observational study

SUMMARY The purpose of this study was to assess and compare with rehabilitative ultrasound imaging (RUSI) the perimuscular connective tissue (PMCT) and interrecti distance (IRD) between elite and amateur basketball players. A sample of 22 healthy basketball players was included and divided into two groups: elite basketball players from Spanish 1st division (n = 11) and amateur basketball players from an entertainment Spanish division (n = 11). Ultrasound images of the external oblique (EO), internal oblique (IO), transversus abdominis (TrAb), rectus anterior (RA) and IRD PMCT were measured and analysed by the ImageJ software. Measurements of abdominal wall muscles PMCT present statistically differences (P < .05) for an increase of perimuscular connective tissue of external oblique (PMCTEO), perimuscular connective tissue of transversus abdominis (PMCTTA) of the left side and an increase of PMCTEO on the right side in favor of the elite group. Rather, the study showed statistically differences (P < .05) for a decrease of perimuscular connective tissue between the internal oblique and transversus abdominis (PMCTIO-TA), and a decrease in PMCT total summation of the left side with elite group in respect to amateur group. This study reported an increase of left PMCTEO, left PMCTTAA, right PMCTEO as well as a decrease of left PMCTIO-TA and in PMCT total summation on the left side.

RESUMO O objetivo deste estudo foi avaliar e comparar com ultrassonografia de reabilitação (IUR) o tecido conjuntivo perimuscular da parede abdominal (PMPA) e interrecti distância (IRD) entre elite e jogadores de basquete amadores. Uma amostra de 22 jogadores de basquete saudáveis foi incluída e dividida em dois grupos: jogadores de basquete de elite da 1ᵃ divisão espanhola (n=11) e jogadores de basquete amadores de uma divisão de entretenimento espanhol (n=11). As imagens de ultrassom do oblíquo externo (OE), oblíquo interno (OI), transverso abdominal (TrAb), recto anterior (RA) e IRD PMPA foram medidas e analisadas pelo software ImageJ. Medições dos músculos da parede abdominal O PMPA apresentam diferenças estatisticamente (P<0,05) para o aumento do tecido conjuntivo perimuscular de oblíquo externo (PMOE), tecido conjuntivo perimuscular de transverso abdominal (PMTA) do lado esquerdo e aumento do PMOE do lado direito a favor do grupo de elite. Em vez disso, o estudo mostrou diferenças estatisticamente (P<0,05) para uma diminuição do tecido conjuntivo perimuscular entre o oblíquo interno e transverso abdominário (PMOI-TA) e uma diminuição no somatório total de PMTA do lado esquerdo do grupo de elite em relação ao amador grupo. Este estudo relatou um aumento do PMTOE esquerdo, PMTA esquerdo, PMCTOE direito, bem como uma diminuição do PMCTOI-TA esquerdo e no somatório total do PMTA no lado esquerdo.

Associations between low back pain, urinary incontinence, and abdominal muscle recruitment as assessed via ultrasonography in the elderly

Background: Low back pain (LBP) and urinary incontinence (UI) are highly prevalent among elderly individuals. In young adults, changes in trunk muscle recruitment, as assessed via ultrasound imaging, may be associated with lumbar spine stability. Objective: To assess the associations between LBP, UI, and the pattern of transversus abdominis (TrA), internal (IO), and external oblique (EO) muscle recruitment in the elderly as evaluated by ultrasound imaging. Method: Fifty-four elderly individuals (mean age: 72±5.2 years) who complained of LBP and/or UI as assessed by the McGill Pain Questionnaire, Incontinence Questionnaire-Short Form, and ultrasound imaging were included in the study. The statistical analysis comprised a multiple linear regression model, and a p-value <0.05 was considered significant. Results: The regression models for the TrA, IO, and EO muscle thickness levels explained 2.0% (R2=0.02; F=0.47; p=0.628), 10.6% (R2=0.106; F=3.03; p=0.057), and 10.1% (R2=0.101; F=2.70; p=0.077) of the variability, respectively. None of the regression models developed for the abdominal muscles exhibited statistical significance. A significant and negative association (p=0.018; β=-0.0343) was observed only between UI and IO recruitment. Conclusion: These results suggest that age-related factors may have interfered with the findings of the study, thus emphasizing the need to perform ultrasound imaging-based studies to measure abdominal muscle recruitment in the elderly. .