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1.
J Bodyw Mov Ther ; 37: 220-225, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38432809

RESUMO

INTRODUCTION: Patellofemoral pain syndrome (PFPS) is prevalent in physically active people. The multifactorial nature of PFPS necessitates multimodal treatment for this condition. The present study aimed to compare the efficacy of lumbopelvic manipulation alone versus manipulation plus dry needling in physically active patients with PFPS. METHOD: Thirty patients (18 women and 12 men) with a diagnosis of PFPS entered this randomized controlled clinical trial and were divided into two groups: lumbopelvic manipulation alone or lumbopelvic manipulation plus dry needling. The interventions were applied for 3 sessions every other day. Dry needling was performed on the quadratus lumborum and gluteus medius muscles. Pain intensity, Kujala score and side-plank time were recorded at baseline, post-intervention and 1 month after the intervention. RESULTS: The results of Friedman's test showed statistically significant differences in pain and function in participants during the study period, and post hoc tests revealed differences between the two groups in behavior of the marginal means (p < 0.001). CONCLUSION: The use of lumbopelvic manipulation plus dry needling in the quadratus lumborum and gluteus medius muscles may be more effective than manipulation alone in alleviating pain and promoting function in physically active patients with PFPS.


Assuntos
Parede Abdominal , Síndrome da Dor Patelofemoral , Masculino , Humanos , Feminino , Síndrome da Dor Patelofemoral/terapia , Músculos Abdominais , Dor
2.
Chirurgia (Bucur) ; 119(1): 102-105, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38465720

RESUMO

video width="640" height="480" controls controlsList="nodownload" poster="https://www.revistachirurgia.ro/pdfs/video/Victor_Gheorghe_Radu_L3W3_Incisional_Hernia.jpg" style="margin-top: -20px;" source src="https://www.revistachirurgia.ro/pdfs/video/Victor_Gheorghe_Radu_L3W3_Incisional_Hernia.mp4" type="video/mp4" Your browser does not support the video tag. /video Introduction: The Rives-Stoppa procedure has emerged as the preferred method for ventral hernia repair, and the principles of this technique are similarly applied in minimally invasive surgery using the eTEP (enhanced view totally extraperitoneal) approach. It appears that the eTEP approach offers excellent outcomes in terms of less post-operative pain, faster recovery, and shorter hospital stays for patients undergoing abdominal wall reconstruction (AWR). It's important to note that there are some contra-indications of this procedure. In general, laparoscopic eTEP may not be suitable for cases with large hernias and loss of domain where the working space is limited. In such cases, alternative approaches, such as using a robotic platform, may be considered to ensure an adequate working space for abdominal wall reconstruction (AWR). A robotic platform can create a working space by using the robotic arms as a "laparo-lift," enabling the AWR to be performed. Case Report: In this case, we have a 65-year-old female patient with a BMI of 28.5 who presents with a large incisional hernia with LOD. This hernia is located on the right flank and occurred after a Jalaguier incision. The CT scan provided valuable information regarding the size of the hernia, the remaining volume of the abdominal cavity, and the content of the hernia sac. Based on these radiological details, the LOD diagnosis was confirmed using the Sabbagh equation, which revealed that the hernia volume accounted for 46.47% of the total peritoneal volume. Based on the location, size of the defect, and the EHS classification for incisional hernias, the diagnosis for this case is a Complex incisional hernia of L3 right W3 with LOD. The protocol for optimization in this case involves chemo-relaxation, which refers to the injection of botulinum toxin A (BTA) into the large lateral muscles of the abdomen. This is done approximately 6 weeks before the surgery. Based on the successful reduction of the hernia during the consultation, the decision has been made to perform the Abdominal Wall Reconstruction (AWR) procedure using the robotic eTEP-TAR technique. Conclusion: The post-operative course was favorable, with the patient experiencing early active mobilization, reduced pain, and early return of bowel movement. The patient was discharged the day after the surgery.


Assuntos
Hérnia Ventral , Hérnia Incisional , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Feminino , Humanos , Idoso , Hérnia Incisional/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Hérnia Ventral/cirurgia , Músculos Abdominais/cirurgia , Laparoscopia/métodos , Herniorrafia/métodos , Telas Cirúrgicas
3.
Surg Clin North Am ; 104(2): 355-366, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38453307

RESUMO

Management of the open abdomen has been used for decades by general surgeons. Techniques have evolved over those decades to improve control of infection, fluid loss, and improve the ability to close the abdomen to avoid hernia formation. The authors explore the history, indications, and techniques of open abdomen management in multiple settings. The most important considerations in open abdomen management include the reason for leaving the abdomen open, prevention and mitigation of ongoing organ dysfunction, and eventual plans for abdominal closure.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais , Laparotomia , Humanos , Laparotomia/métodos , Abdome/cirurgia , Músculos Abdominais/cirurgia
6.
BMC Anesthesiol ; 24(1): 87, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38429757

RESUMO

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common postoperative complication, and Transversus abdominis plane (TAP) block can provide effective analgesia for surgical operation. However, but there is not enough evidence to prove its advantage for nausea and vomiting. The objective of this meta-analysis was to evaluate the efficacy of TAP block on PONV. METHODS: Two independent researchers conducted searches for randomized controlled trials (RCTs) in PubMed, Embase, and Cochrane Central Register of Controlled Trials. We used Review Manager software for meta-analysis. RESULTS: In this meta-analysis, twenty-six trials with 1981 patients were examined. The results showed that TAP block reduced postoperative nausea (Risk Difference (RD) = -0.10, 95% confidence interval (CI): -0.15 to -0.05) compared with no TAP block. TAP block reduced the dose of fentanyl (Standardized Mean Difference (SMD) = -1.17, 95% CI: -2.07 to -0.26) and morphine (SMD = -1.12, 95% CI: -2.10 to -0.13) compared with no TAP block, when the timing of administration was before surgery (RD = -0.13, 95% CI: -0.19 to -0.07). TAP block reduced postoperative nausea when the ropivacaine dosage is ≤ 100 mg (RD = -0.13, 95% CI: -0.21 to -0.06), bupivacaine dosage ≥ 100 mg ( RD = -0.08, 95% CI: -0.13 to -0.03), and when the ropivacaine concentration was ≤ 0.375% (RD = -0.11, 95% CI: -0.18 to -0.04). TAP block significantly reduced the incidence of nausea when the types of opioid drugs in PCA is tramadol (RD = -0.13, 95% CI: -0.24 to -0.03). TAP block could reduce the VAS (SMD= -0.99, 95% CI: -1.29 to -0.70) and reduce the time of extubation (SMD = -0.71, 95% CI: -1.34 to -0.08). CONCLUSION: The meta-analysis conducted in this study revealed that TAP block could reduce the incidence of PONV, and the efficacy of TAP block may be influenced by factors such as administration time, local anesthetic dosage and concentration, types of opioid drugs in PCA.


Assuntos
Analgésicos Opioides , Náusea e Vômito Pós-Operatórios , Humanos , Náusea e Vômito Pós-Operatórios/prevenção & controle , Ropivacaina/farmacologia , Músculos Abdominais , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/etiologia
7.
J Musculoskelet Neuronal Interact ; 24(1): 47-54, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38427368

RESUMO

OBJECTIVES: Progressive proximal muscle weakening in children with Duchenne muscular dystrophy (DMD) impairs postural adjustments by impairing motor function and preventing ambulation. During daily activities, for gait and dynamic balance, certain postural modifications are required. The objective was to compare the impact of trunk-oriented exercises versus whole-body vibration on abdominal muscle thickness and balance in children with DMD. METHODS: Participants in this study were 30 boys with DMD, aged 6 to 10 years old. Children were divided into two groups (A and B) randomly. Children in group (A) underwent a prescribed regimen of physical therapy along with trunk-oriented exercises, whereas group (B) received the same regimen as group (A) together with whole-body vibration three times per week for three consecutive months. Balance and the thickness of the abdominal muscles were measured using the Biodex balance system and ultrasonography, respectively, before and after therapy. RESULTS: When compared to the pre-treatment results in both groups, the post-treatment results showed a significant difference in all measured variables (p<0.05). Post-treatment values showed that all of the measured variables significantly differed in favor of group A. CONCLUSIONS: Trunk-oriented exercises can improve abdominal thickness and balance more effectively than whole-body vibration in children with DMD. CLINICALTRIALS: gov ID: NCT05688072.


Assuntos
Distrofia Muscular de Duchenne , Vibração , Masculino , Criança , Humanos , Vibração/uso terapêutico , Terapia por Exercício/métodos , Exercício Físico , Distrofia Muscular de Duchenne/terapia , Músculos Abdominais/diagnóstico por imagem , Equilíbrio Postural/fisiologia
8.
Georgian Med News ; (346): 63-67, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38501623

RESUMO

The separation of the two rectus abdominis muscles along the linea alba is termed diastasis of recti abdominis muscles (DRAM). DRAM is a common health problem in people that are both pregnant and postpartum. With a 100% frequency at gestational week 35, it is extremely frequent during pregnancy. Control and function of the trunk are greatly influenced by the musculature of the abdomen. The existence, extent, and duration of DRAM have been connected to low back and pelvic discomfort however the relationship is not conclusive. It has been proven to weaken abdominal muscles and impair their functioning in lumbo-pelvic stability. Additionally, DRAM has been linked to pelvic floor dysfunction. The mechanical control and function of the abdomen can be compromised by diastasis recti, which compromises the abdominal muscles. This study examined the impact of abdominal exercises and neuromuscular electrical stimulation on the DRAM in postnatal females who underwent Caesarean section. A total of 208 individuals, aged between 20 and 34, who had recti diastasis measuring more than 2.5 cm, underwent screening. They were split into two groups at random. Group B only received abdominal exercises, whereas Group A received NMES in addition to their activities. For a period of 12 weeks, the intervention was given to both groups three times a week. Changes have been recorded before and after the intervention. The pressure biofeedback unit, measuring tape, and vernier caliper were employed to evaluate the outcome measures of inter-recti distance, abdominal muscle strength, and waist-hip ratio, respectively. In every outcome, both groups had a highly significant (p<0.05) improvement. Furthermore, after 12 weeks, group A had improved in all measures with highly significant (p<0.05) intergroup comparisons. In comparison to MNES alone, NMES can have a more significant effect on reducing DRAM in postpartum women when paired with abdominal Exercise.


Assuntos
Diástase Muscular , Reto do Abdome , Feminino , Gravidez , Humanos , Adulto Jovem , Adulto , Cesárea , Músculos Abdominais , Terapia por Exercício , Diástase Muscular/terapia , Estimulação Elétrica
9.
BMC Anesthesiol ; 24(1): 58, 2024 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-38336613

RESUMO

BACKGROUND: Rectus sheath block (RSB) and transversus abdominis plane block (TAPB) have been shown to reduce opioid consumption and decrease postoperative pain scores in abdominal surgeries. However, there are no reports about the one-puncture technique of RSB combined with TAPB for perioperative pain management during laparoscopic upper abdominal surgery. METHODS: A total of 58 patients were randomly assigned to the control group (C), the TAP group (T), and the one-puncture technique of RSB combined with TAPB group (RT). The patients in group C did not receive any regional block. The patients in group T received ultrasound-guided subcostal TAPB with 30 mL of 0.33% ropivacaine on each side. The patients in the RT group received a combination of RSB and TAPB with 15 mL of 0.33% ropivacaine in each plane by one puncture technique. All patients received postoperative patient-controlled intravenous analgesia (PCIA) after surgeries. The range of blocks was recorded 20 min after the completion of the regional block. The postoperative opioid consumption, pain scores, and recovery data were recorded, including the incidence of emergence agitation (EA), the times of first exhaust and off-bed activity, the incidence of postoperative nausea and vomiting, dizziness. RESULTS: The range of the one-puncture technique in group RT covered all areas of surgical incisions. The visual analogue scale (VAS) score of the RT group is significantly lower at rest and during coughing compared to groups T and C at 4, 8, 12, and 24 h after surgery, respectively (P < 0.05). The consumption of sufentanil and the number of postoperative compressions of the analgesic pumps at 24 and 48 h in the RT group are significantly lower than those in groups T and C (P < 0.05). The incidence of EA in the RT group is significantly lower than that in groups T and C (P < 0.05). CONCLUSION: The one-puncture technique of RSB combined with TAPB provides effective postoperative analgesia for laparoscopic upper abdominal surgery, reduces the incidence of EA during PACU, and promotes early recovery. TRIAL REGISTRATION: ChiCTR, ChiCTR2300067271. Registered 3 Jan 2023, http://www.chictr.org.cn .


Assuntos
Benzamidinas , Laparoscopia , Manejo da Dor , Humanos , Ropivacaina , Manejo da Dor/efeitos adversos , Estudos Prospectivos , Analgésicos Opioides , Anestésicos Locais , Músculos Abdominais , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/etiologia , Laparoscopia/métodos , Analgesia Controlada pelo Paciente/métodos , Náusea e Vômito Pós-Operatórios , Punções
10.
Curr Pain Headache Rep ; 28(4): 251-257, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38340209

RESUMO

PURPOSE OF REVIEW: Chronic abdominal wall pain is a poorly recognized cause of chronic abdominal pain, and patients frequently go misdiagnosed despite a battery of medical tests. The Carnett's test is a diagnostic tool used to distinguish between abdominal wall pain and visceral pain. This review synthesizes the current literature on the Carnett's test, merges the viewpoints of diverse writers, and evaluates and reports on the Carnett's test's applicability. RECENT FINDINGS: Several clinical investigations have established the usefulness of the Carnett's test in the diagnosis of chronic abdominal wall pain. Furthermore, the Carnett's test is quite useful in determining the depth of the mass and detecting psychogenic abdominal pain. However, its diagnostic use for acute abdominal pain is limited. The Carnett's test is a simple and safe point-of-care diagnostic technique, with several studies supporting its usefulness. Early detection of abdominal wall pain is critical for chronic abdominal wall pain therapy. Carnett's test is very useful in patients with chronic, unexplained local abdominal discomfort who are compliant and do not have a clear rationale for surgery.


Assuntos
Parede Abdominal , Dor Crônica , Dor Visceral , Humanos , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/terapia , Músculos Abdominais , Manejo da Dor , Dor Crônica/diagnóstico , Dor Crônica/etiologia
11.
Sci Rep ; 14(1): 3740, 2024 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-38355873

RESUMO

Drosophila melanogaster has a pair of male-specific muscles called the muscle of Lawrence (MOL) in abdominal segment 5 (A5) of adult flies. The MOL is produced only when its innervating motoneuron expresses FruitlessM (FruM) neural masculinizing proteins. We show that MOL induction is hampered by: (1) silencing electrical activities in the motoneuron, (2) blocking vesicular release from the motoneuron, and (3) knocking down Activin ß (Actß) in the motoneuron or knocking down Actß signaling pathway components in the myoblasts. Our timelapse live imaging of the developing neuromuscular system reveals that, upon contact with the presumptive MOL, the motoneuronal axon retracts concomitant with the progression of MOL degeneration resulting from neural silencing. We conclude that MOL formation depends on the bidirectional trophic interactions between pre- and postsynaptic cells, with motoneuron-derived Actß playing an inducing role in MOL formation.


Assuntos
Proteínas de Drosophila , Drosophila , Animais , Masculino , Drosophila melanogaster , Ativinas , Proteínas de Drosophila/genética , Músculos Abdominais , Axônios
13.
J Am Heart Assoc ; 13(4): e032014, 2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-38348808

RESUMO

BACKGROUND: Muscle density is inversely associated with all-cause mortality, but associations with cardiovascular disease (CVD) risk are not well understood. This study evaluated the association between muscle density and muscle area and incident total CVD, coronary heart disease (CHD), and stroke in diverse men and women. METHODS AND RESULTS: Adult participants (N=1869) in the Multi-Ethnic Study of Atherosclerosis Ancillary Body Composition Study underwent computer tomography scans of the L2-L4 region of the abdomen. Muscle was quantified by density (Hounsfield units) and area in cm2. Sex-stratified Cox proportional hazard models assessed associations between incident total CVD, incident CHD, and incident stroke across sex-specific percentiles of muscle area and density, which were entered simultaneously into the model. Mean age for men and women at baseline were 64.1 and 65.1 years, respectively, and median follow-up time was 10.3 years. For men, associations between muscle density and incident CVD were inverse but not significant in fully adjusted models (P trend=0.15). However, there was an inverse association between density and CHD (P trend=0.02; HR, 0.26 for 95th versus 10th percentile), and no association with stroke (P trend=0.78). Conversely, for men, there was a strong positive association between muscle area and incident CVD (HR, 4.19 for 95th versus 10th percentile; P trend<0.001). Associations were stronger for CHD (HR, 6.18 for 95th versus 10th percentile; P trend<0.001), and null for stroke (P trend=0.67). Associations for women were mostly null. CONCLUSIONS: For men, abdominal muscle density is associated with lower CHD risk, whereas greater muscle area is associated with markedly increased risk of CHD.


Assuntos
Aterosclerose , Doenças Cardiovasculares , Doença das Coronárias , Acidente Vascular Cerebral , Masculino , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Fatores de Risco , Estudos Prospectivos , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Músculos Abdominais/diagnóstico por imagem , Incidência
14.
Clin Transplant ; 38(1): e15227, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38289879

RESUMO

Transplantation surgery continues to evolve and improve through advancements in transplant technique and technology. With the increased availability of ultrasound machines as well as the continued development of Enhanced Recovery after Surgery (ERAS) protocols, regional anesthesia has become an essential component of providing analgesia and minimizing opioid use perioperatively. Many centers currently utilize peripheral and neuraxial blocks during transplantation surgery, but these techniques are far from standardized practices. The utilization of these procedures is often dependent on transplantation centers' historical methods and perioperative cultures. To date, no formal guidelines or recommendations exist which address the use of regional anesthesia in transplantation surgery. In response, the Society for the Advancement of Transplant Anesthesia (SATA) identified experts in both transplantation surgery and regional anesthesia to review available literature concerning these topics. The goal of this task force was to provide an overview of these publications to help guide transplantation anesthesiologists in utilizing regional anesthesia. The literature search encompassed most transplantation surgeries currently performed and the multitude of associated regional anesthetic techniques. Outcomes analyzed included analgesic effectiveness of the blocks, reduction in other analgesic modalities-particularly opioid use, improvement in patient hemodynamics, as well as associated complications. The findings summarized in this systemic review support the use of regional anesthesia for postoperative pain control after transplantation surgeries. Part 1 of the manuscript focused on regional anesthesia performed in thoracic transplantation surgeries, and part 2 in abdominal transplantations. Specifically, regional anesthesia in liver, kidney, pancreas, intestinal, and uterus transplants or applicable surgeries are discussed.


Assuntos
Analgésicos Opioides , Anestesia por Condução , Feminino , Humanos , Dor Pós-Operatória , Anestesia por Condução/métodos , Músculos Abdominais , Analgésicos
15.
Med Sci Sports Exerc ; 56(2): 193-208, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38214537

RESUMO

PURPOSE: We quantified the relationship between high-density surface electromyographic (HDsEMG) oscillations (in both time and frequency domains) and torque steadiness during submaximal concentric/eccentric trunk extension/flexion contractions, in individuals with and without chronic low back pain (CLBP). METHODS: Comparisons were made between regional differences in HDsEMG amplitude and HDsEMG-torque cross-correlation and coherence of the thoracolumbar erector spinae (ES), rectus abdominis (RA), and external oblique (EO) muscles between the two groups. HDsEMG signals were recorded from the thoracolumbar ES with two 64-electrode grids and from the RA and EO muscles with a single 64-electrode grid placed over each muscle. Torque signals were recorded with an isokinetic dynamometer. Coherence (δ band (0-5 Hz)) and cross-correlation analyses were used to examine the relationship between HDsEMG and torque signals. For this purpose, we used principal component analysis to reduce data dimensionality and improve HDsEMG-based torque estimation. RESULTS: We found that people with CLBP had poorer control during both concentric and eccentric trunk flexion and extension. Specifically, during trunk extension, they exhibited a higher HDsEMG-torque coherence in more cranial regions of the thoracolumbar ES and a higher HDsEMG cross-correlation compared with asymptomatic controls. During trunk flexion movements, they demonstrated higher HDsEMG amplitude of the abdominal muscles, with the center of activation being more cranial and a higher contribution of this musculature to the resultant torque (particularly the EO muscle). CONCLUSIONS: Our findings underscore the importance of evaluating torque steadiness in individuals with CLBP. Future research should consider the value of torque steadiness training and HDsEMG-based biofeedback for modifying trunk muscle recruitment strategies and improving torque steadiness performance in individuals with CLBP.


Assuntos
Dor Lombar , Humanos , Torque , Músculo Esquelético/fisiologia , Tronco/fisiologia , Músculos Abdominais/fisiologia , Eletromiografia , Reto do Abdome
16.
Surg Radiol Anat ; 46(2): 203-210, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38182780

RESUMO

INTRODUCTION: The present study examined the morphology and morphometric parameters of the pyramidalis muscle (PM) in detail with their potential applicability in making midline infra-umbilical incisions and biomechanics of the linea alba. METHODS: PM was examined in 51 formalin-fixed cadavers (36 males and 15 females), and based on the mode of insertion or the level of apex, the formation or shape of the muscle was classified into nine types (Mori's classification). RESULTS: Bilateral PM was more prevalent (39.21%) than unilateral (1.96%) (p = 0.001). All the cases showed side symmetry except one. Mori's type 7 (right PM is higher apex and the left PM with elongated origin) was the most common form. The mean length of PM in males and females was 4.51 ± 0.14 and 3.33 ± 0.12 cm on the right and 4.51 ± 0.11 and 3.26 ± 0.16 cm on the left side. The mean width of right-sided PMs in males and females was 1.90 ± 0.17 and 1.58 ± 0.13 cm and left-sided 1.88 ± 0.14 and 1.55 ± 0.38 cm. The mean of pyramidalis-pubo-umbilical index (PPI) in males and females was 32.82 ± 1.65 and 27.50 ± 1.08, respectively. The mean insertion angle was 24.56 ± 3.07 on right side and 23 ± 2.03 on the left side (p = 0.03). Male predominance existed on right- and left-sided PM length (p < 0.001 and p < 0.001), width (p = 0.001) and PPI (p = 0.001). The strong positive correlation (r = 0.83) between length and width indicates a symmetrical muscle augmentation in the two dimensions. CONCLUSION: PM is an inconsistent anatomical structure with persistent morphology. The level and angle of insertion into the linea are crucial in the biomechanics of linea alba. PPI, determining the termination level would be useful to surgeons making midline infra-umbilical incisions.


Assuntos
Parede Abdominal , Cirurgiões , Feminino , Humanos , Masculino , Músculos Abdominais/anatomia & histologia , Cadáver , Umbigo
17.
World J Surg ; 48(3): 610-621, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38265244

RESUMO

INTRODUCTION: Postoperative pain management is crucial for patient recovery with Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) emerging as potential techniques. We aimed to compare the analgesic efficacy of QLB and TAPB in patients undergoing inguinal hernia repair. METHODS: We performed a systematic review of Cochrane, EMBASE, and MEDLINE databases to identify randomized controlled trials comparing QLB and TAPB in patients undergoing inguinal hernia repair. Outcomes included postoperative pain and opioid consumption. Statistical analysis was performed using RevMan 5.4. The review protocol was registered at PROSPERO (CRD42023445513). RESULTS: We included five RCTs encompassing 255 patients. QLB was associated with a significant decrease in postoperative pain (MD -0.45; 95% CI -0.75 to -0.14; and p = 0.004; I2  = 94%). However, we found no difference in 24-h opioid consumption between QLB and TAPB groups. CONCLUSION: QLB may offer superior pain reduction. However, its effect on opioid consumption remains unclear.


Assuntos
Analgésicos Opioides , Hérnia Inguinal , Humanos , Músculos Abdominais , Analgésicos Opioides/uso terapêutico , Anestésicos Locais , Hérnia Inguinal/cirurgia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Congenit Anom (Kyoto) ; 64(2): 32-39, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38273805

RESUMO

The pyramidalis muscle (PM) is a paired small triangular muscle of the anterior abdominal wall; however, its physiological significance is unclear. Recent studies have failed to detect this muscle during embryonic period. Hence, the present study aimed to determine the time when PM is emerging and reveal its features using high-resolution magnetic resonance imaging. Fourteen embryos between Carnegie stage (CS)18 and CS23 and 59 fetuses (crown-rump length: 39.5-185.0 mm) were selected for this study. The PM was first detected in one of the three samples at CS20. It was detected in five of the seven samples (71.4%) between CS21 and CS23. Forty-eight samples (81.4%) at early fetal period had PMs on both the right and left sides, and 3 (5.1%) had it only on the right side. Eight samples (13.6%) had no PMs. No side-differences or sexual dimorphisms were detected. The PM length was larger than the width in most samples, although the length/width ratio varied among the samples. The PM/rectus abdominis muscle length and PM/umbilicus-pubic symphysis length ratios were almost constant, irrespective of the crown-rump length. The PM was located ventrally inferior to the rectus abdominis and closer to the medial muscle groups of the lower limb than the rectus abdominis. The present study demonstrated that PM formation occurred in the late embryonic period, and that the frequency, side differences, sex dimorphism, and spatial position of the PM in the early fetal period were similar to those in adults.


Assuntos
Músculos Abdominais , Reto do Abdome , Adulto , Humanos , Músculos Abdominais/diagnóstico por imagem , Imageamento por Ressonância Magnética
20.
Surg Endosc ; 38(3): 1119-1130, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38253697

RESUMO

BACKGROUND: The transversus abdominis plane block (TAPB) is effective for postoperative pain management in patients undergoing colorectal surgery. However, evidence regarding the optimal delivery method, either laparoscopic (L-TAPB) or ultrasound-guided (U-TAPB) is lacking. Our study aimed to compare the effectiveness of these delivery methods. METHODS: We carried out a literature search of PubMed, Cochrane Library, Web of Science, and Google Scholar databases to include randomized studies comparing patients receiving either L-TAPB or U-TAPB during minimally invasive colorectal surgery. The primary endpoint was opioid consumption in the first 24 h after surgery. Risk of bias was assessed with the RoB-2 tool. Effect size was estimated for each study with 95% confidence interval and overall effect measure was estimated with a random effect model. RESULTS: The literature search revealed 294 articles, of which four randomized trials were eligible. A total of 359 patients were included, 176 received a L-TAPB and 183 received a U-TAPB. We established the non-inferiority of L-TAPB, as the absolute difference of - 2.6 morphine-mg (95%CI - 8.3 to 3.0) was below the pooled non-inferiority threshold of 8.1 morphine-mg (low certainty level). No difference in opioid consumption was noted at 2, 6, 12, and 48 h (low to very low certainty level). Postoperative pain, nausea and vomiting were similar between groups at different timepoints (low to very low certainty level). No TAPB-related complications were recorded. Finally, the length of hospital stay was similar between groups. CONCLUSION: For postoperative multimodal analgesia both L-TAPB and U-TAPB may result in little to no difference in outcome in patients undergoing colorectal surgery. Registration Prospero CRD42023421141.


Assuntos
Benzamidinas , Cirurgia Colorretal , Laparoscopia , Humanos , Analgésicos Opioides/uso terapêutico , Anestésicos Locais , Músculos Abdominais/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Laparoscopia/métodos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/cirurgia , Morfina , Ultrassonografia de Intervenção/efeitos adversos
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