Transversus Research Articles

Four-point transversus abdominis plane block technique in pigs. A pilot cadaveric study

Four-point transversus abdominis plane block technique in pigs. A pilot cadaveric study

The investigation of ultrasound to assess lateral abdominal wall activation with different types of core exercises

BackgroundCore training is the foundation of physical exercise. The activation of the lateral abdominal wall (LAW) muscles in the core muscles, particularly the transversus abdominal (TrA) muscles, has a stabilizing effect on the chest and abdomen. Therefore, we need to focus on the training effect of the TrA. There are many ways to measure the LAW. Ultrasound can assess the effect of training in real time and intuitively. Therefore, we intend to evaluate the activation of the LAW in different types of core training using ultrasound, to determine the best movements that can activate the TrA and train the core muscles.Methods22 healthy subjects (male 10, female 12, age 22.82 ± 0.98, BMI 20.78 ± 2.27) were included. The subjects were given the following instructions to perform breathing exercises at different positions: calm breathing and deep breathing at 0° hip flexion and 0° knee flexion; calm breathing, deep breathing, abdominal crunches and ball crunches at 45° hip flexion and 90° knee flexion; and calm breathing, deep breathing, abdominal crunches and ball crunches at 90° hip flexion and 90° knee flexion. The muscle thicknesses of the bilateral transversus abdominis (TrA), internal oblique (IO), external oblique (EO), and LAW muscles were measured using ultrasonography at the end of expiration during the above movements.Results(1) The action with the greatest contraction ratio of the TrA was deep exhalation, which was significantly greater than crunch and ball crunch; (2) During deep exhalation, the TrA had the greatest contraction ratio, significantly greater than the IO and EO. (3) The TrA was thinnest during deep exhalation at 90°, followed by 45° and 0°.ConclusionIn healthy young people, deep expiration with 90° hip flexion and 90° knee flexion was the optimal action for activating the LAW, especially the TrA.

Thoracic Epidural and Analgesic Options After Failed Transversus Abdominus Plane Block With Liposomal Bupivacaine.

A 39 year-old female with a history of Roux-en-Y gastric bypass underwent emergent partial colectomy. Her postoperative analgesic management of a transversus abdominus plane block administered with a combination of bupivacaine and liposomal bupivacaine was ineffective. A bupivacaine thoracic epidural was then placed, which provided significant pain relief. This use of a bupivacaine thoracic epidural infusion following liposomal bupivacaine regional anesthesia demonstrated a case of effective analgesia without the development of local anesthetic systemic toxicity symptoms in a remote hospital setting, where certain laboratory analyses were not readily available.

Innovations in Pain Management for Abdominoplasty Patients: A Systematic Review

Background/Objectives: Abdominoplasties are prevalent surgical procedures for improving lower abdominal contours, necessitating effective pain management. Insufficient management can increase opioid usage, dependency risks, and adverse effects. This review investigates various strategies in abdominoplasty pain management, aiming to reduce opioid dependence and improve patient care. Methods: A comprehensive systematic literature search (MEDLINE, Cochrane, PubMed, Web of Science, EMBASE) was conducted, spanning from their inception to January 2024, using keywords such as ‘abdominoplasty’ and ‘postoperative pain management’. Included studies focused on nonopioid interventions in adults, encompassing various study designs. Non-English publications and those not meeting outcome criteria were excluded. Bias in studies was assessed using specific tools for randomized and non-randomized trials. Results: Thirty-five studies, published between 2005 and 2024, were included, involving 3636 patients with an average age of 41.8. Key findings highlighted the effectiveness of transversus abdominis plane blocks in reducing opioid use and pain. Pain pump catheters also showed promise in improving pain management and reducing opioid dependency. Local anesthetics demonstrated varying degrees of efficacy, while other alternatives like ketamine and NSAIDs successfully reduced postoperative pain and opioid requirements. The bias assessment of the RCTs revealed “low” and “some concerns” ratings, indicating a need for more detailed methodology reporting and management of missing data. The cohort studies generally attained “moderate” risks of bias, primarily due to confounding variables and outcome data reporting. Conclusions: Nonopioid analgesics show potential in postoperative pain management for abdominoplasties, but further research is needed to confirm their effectiveness and optimize patient care.

Morphological Changes in the Lumbar and Abdominal Muscles in Individuals with Sacralization

Although sacralization is one of the most common congenital anomalies of the spine, its effect on surrounding muscles is still not well known. This study was conducted to determine the size of the lumbar and abdominal muscles of the individuals with sacralization and to compare with the control group. Eighty-five participants with sacralization phenomena and fifty-six asymptomatic participants were included in this study. Sacralization was classified according to the Castellvi classification. The cross-sectional area of the multifidus lumborum, erector spinae and rectus abdominis muscles, and the section thicknesses of external abdominal oblique, internal abdominal oblique and transversus abdominis muscles were measured bilaterally on axial computed tomography images at the L1-2 and L4-5 levels. ANCOVA revealed that there is no any significant group*side interaction effect regarding muscles sizes in terms of two groups in L1-L2 and L4-L5. In addition, ANCOVA revealed a both side effect [(p=.020; η2p=.038)] and group*side interaction effect [(p=.010; η2p=.049)] regarding length of the L5 transverse process (p˃.05). Regardless of low back pain, muscle sizes are not associated with the sacralization phenomenon.

Postoperative early initiation of sequential exercise program in preventing persistent spinal pain syndrome type-2 after modified transforaminal lumbar interbody fusion: a prospective randomized controlled trial.

This prospective randomized controlled trial aimed to investigate the impact of early postoperative sequential motor control (starting first day post-operatively) and core stabilization training (starting fifth week post-operatively) compared to conventional exercise (starting fifth weeks post-operatively) on the risk of developing persistent spinal pain syndrome type-2 (PSPS-T2). 395 patients with lumbar degenerative diseases (LDDs) undergoing modified transforaminal lumbar interbody fusion and a 12-week postoperative exercise program (sequential vs. conventional exercise: 214 vs. 181) were evaluated for low back pain (LBP) intensity, Oswestry Disability Index (ODI), pressure pain threshold (PPT), temporal summation (TS), fatty infiltration of paraspinal muscles, transversus abdominis (TrA) activation capacity and Fear-Avoidance Beliefs Questionnaire (FABQ) pre-operatively, 3 months post-operatively, and 1 year post-operatively. At 3-month postoperative assessment, LBP in sequential exercise group were lower than those in conventional exercise group (P < 0.05), and sequential-exercise patients had greater local-area PPTs, lower TS, lower TrA activation capacities and less fatty infiltration of erector spinae than did the conventional-exercise patients (P < 0.05). At 1-year postoperative assessment, fewer sequential-exercise patients had PSPS-T2 compared with conventional-exercise patients (11/214 vs. 20/181; P < 0.05). LBP at rest and FABQ were lower in sequential-exercise patients than conventional-exercise patients (P < 0.05). Furthermore, both PPT and TS at 1-year postoperative assessment were associated with these measurements at 3-month postoperative assessment in patients with PSPS-T2 (P < 0.05). Postoperative sequential exercise has more positive effects to avoid PSPS-T2 than conventional exercise in patients with LDDs possibly because of its advantages in improving central and peripheral sensitization.

Comparison of the clinical efficacy on chronic abdominal wall pain between trigger-point electroacupuncture and transversus abdominis plane block

To compare the clinical efficacy between trigger-point (TrP) electroacupuncture and transversus abdominis plane (TAP) block in treatment of chronic abdominal wall pain (CAWP). A total of 62 CAWP patients were randomly divided into a TrP electroacupuncture group (31 cases, 1 case dropped off) and a TAP block group (31 cases, 1 case dropped off). Electroacupuncture at trigger points was delivered in the TrP electroacupuncture group, and TAP block was administered under ultrasonic guidance in the TAP block group. Separately, the score of the numerical pain rating scale (NRS) was observed before treatment and in 1 week, 1 month and 3 months after treatment；the scores of the self-rating anxiety scale (SAS) and the self-rating depressive scale (SDS) observed before treatment and in 1 week and 3 months after treatment；and the score of the short form 36 questionnaire (SF-36) was observed before treatment and in 3 months after treatment. The utilization rate of remedial drugs was recorded during follow-up visit. The clinical efficacy was compared. At each time point after treatment, NRS score decreased in comparison with that before treatment (P<0.05), the scores of SAS and SDS 1 week and 3 months after treatment were reduced (P<0.05) and the each item score of SF-36 increased (P<0.05) 3 months after treatment of each group. Compared with the outcomes in the TAP block group, NRS scores were reduced 1 month and 3 months after treatment respectively (P<0.05), the scores of SAS and SDS decreased (P<0.05) and SF-36 score was elevated (P<0.05) 3 months after treatment in the TrP electroacupuncture group. There was no significant difference in the utilization rate of remedial drugs between the two groups. The clinical efficacy of the TrP electroacupuncture group (96.7%) was superior to that of the TAP block group (83.3%, P<0.05). Both TrP electroacupuncture and TAP block can markedly relieve pain, attenuate the emotional symptoms of anxiety and depression and improve the quality of life in the patients with chronic abdominal wall pain. The clinical efficacy of TrP electroacupuncture is better than that of TAP block 3 months after treatment.

A randomised comparison of transverse abdominal plane block versus thoracic epidural analgesia on postoperative opioid consumption for colorectal enhanced recovery after surgery programme (OPIATE study).

The transverse abdominis plane block is increasingly being used as a less-invasive alternative to thoracic epidural analgesia for effective pain management. This study aimed to compare transverse abdominis plane block with opioid-based thoracic epidural analgesia in terms of postoperative opioid consumption. Patients in the thoracic epidural analgesia group received a continuous infusion of 0.1% levobupivacaine with 2mcg/ml of fentanyl, while those in the transverse abdominis plane group received 6-hourly boluses of 0.4ml/kg of 0.25% levobupivacaine. The primary objective was to compare the average fentanyl consumption, measured as intravenous fentanyl equivalents, over 72 hours. Data of 35 patients were analysed. Fentanyl consumption at the end of 72 hours was significantly lower in the transverse abdominis plane group (median [interquartile range] 495 mcg (255, 750), and mean (95% confidence interval) 717.35mcg (403.54-1031.16)) compared to the thoracic epidural analgesia group (median [interquartile range] 760mcg (750, 760), and mean (95% confidence interval) 787mcg (746.81-827.19)) with a p value of 0.010. Pain scores at rest and during movement were comparable between the groups (p > 0.05). However, the median pain scores during movement were significantly lower in the thoracic epidural analgesia group at 60 and 72 hours (p ⩽ 0.05). Multimodal analgesia with transverse abdominis plane resulted in lower opioid consumption over 72 hours compared to thoracic epidural analgesia.

Laparoscopic-Assisted, Percutaneous Cryoablation: A Novel Technique for the Treatment of Abdominal Wall Soft Tissue Tumors.

Percutaneous cryoablation is a first-line therapeutic option for primary neoplasms and metastatic lesions of the musculoskeletal system. Treatment of abdominal wall tumors is challenging as surgical resection can be highly morbid and necessitate complex reconstructive surgery; the efficacy of cryoablation for abdominal wall tumors may be limited by inadequate posterior margins owing to the proximity of intra-abdominal organs. With laparoscopy and insufflation, peritoneal structures can be safely mobilized away from the abdominal wall, allowing for adequate deep margin freeze and visualization of the ice ball. We present two patients with abdominal wall soft tissue tumors treated with a novel approach of laparoscopic-assisted, percutaneous ultrasound-guided cryoablation. Patient 1 is a 65-year-old female with metastatic extraskeletal myxoid chondrosarcoma, stable on systemic therapy, who presented with a new soft tissue metastasis to the abdominal wall. Resection would have necessitated a highly morbid complex abdominal wall reconstruction with mesh. Patient 2 is a 35-year-old female with a large abdominal wall desmoid tumor, diagnosed after miscarriage. Resection was relatively contraindicated owing to the morbidity of a complex abdominal wall reconstruction and concerns regarding potential future pregnancies after surgery. Both patients underwent procedures in the outpatient setting after discussion at multidisciplinary sarcoma tumor board. Laparoscopic enterolysis was performed to mobilize the bowel away from the abdominal wall, to allow direct visualization of the peritoneal aspect of the tumor, and to confirm adequacy of the posterior margin freeze of the lesion. Laparoscopic transversus abdominus preperitoneal (TAPP) blocks with local anesthetic were performed for postoperative pain control. Interventional radiology performed an ultrasound-guided cryoablation consisting of two freeze and thaw cycles. Both patients recovered well without complications and were without radiographic evidence of persistent or recurrent disease at 12 and 18 months postoperatively, respectively. We report a novel approach of laparoscopic-assisted cryoablation for the treatment of abdominal wall soft tissue tumors. This allowed for successful minimally invasive local control of these large tumors that would have otherwise required highly morbid resections with complex abdominal wall reconstruction and mesh repair.

Comparative study between Ultrasound Guided Erector Spinae Plane Block Versus Ultrasound Guided Transversus Abdominis Plane Block with Dexmedetomidine as an adjuvant to local anesthetic in Laparoscopic Upper abdominal Surgery.

Comparative study between Ultrasound Guided Erector Spinae Plane Block Versus Ultrasound Guided Transversus Abdominis Plane Block with Dexmedetomidine as an adjuvant to local anesthetic in Laparoscopic Upper abdominal Surgery.

Predicting thenar motor branch anatomy for a safer carpal tunnel release

PurposeAnatomic variations of the thenar motor branch of the median nerve (TMB) that place the nerve more ulnarly in the palm can increase the risk for iatrogenic injury to the nerve during carpal tunnel release. This study examines the prevalence of an origin of the TMB that is more ulnar than its typical branching from the radial aspect of the median nerve and explores whether the appearance of the palmar intrinsic muscles at surgery can predict an unusual TMB origin prior to visualizing the TMB itself. MethodsA prospective study of patients undergoing carpal tunnel release surgery was undertaken to document the take-off point of the TMB along the circumference of the median nerve and the presence or absence of intrinsic muscle obscuring the distal transverse carpal ligament. ResultsForty-one hands were evaluated. Eleven (26.8 %) demonstrated transverse carpal muscle. The most common origin of the TMB was from the radial aspect of the median nerve (56.1 %). In approximately 20 % of nerves, the TMB originated near its anterior midline. There was a statistically significant relationship between the TMB originating more ulnarly and the presence of transverse carpal muscle. ConclusionsThis study introduces a new classification system for further defining anatomic variations of the TMB. When transverse carpal muscle is absent, the TMB is highly likely to arise from the radial aspect of the median nerve. In the presence of transverse carpal muscle, the origin of the TMB is unpredictable and is significantly more likely to arise from the median nerve more ulnarly than is typically seen. Under these circumstances, attempts should be made to identify the TMB prior to completing ligament division.

Abdominal wall muscle ultrasound assessment and level of experience in Pilates - an exploratory study

The core refers to a group of muscles that allow optimal force transfer along the body’s kinetic chain and is critical for movement. The goal of this quasi-experimental study was to investigate the relationship between the experience level of Pilates participants and abdominal wall thickness. For this, we compared the thickness of four abdominal muscles—transversus abdominis (TrA), internal oblique (IO), external oblique (EO), and rectus abdominis (RA)—as measured before and after 8 weeks of Pilates training in three conditions, namely, relaxation, abdominal hollowing, and plank exercise. Eighteen participants were distributed into three groups with different levels of Pilates practice—experienced (EG; n=6), inexperienced (IG; n=7), and control (CG; n=5) groups. The RA showed a tendency to increase post-intervention in the EG (all conditions: p=0,002, p=0,006, and p=0,002, respectively for relaxation condition, abdominal hollowing and standing plank). Additionally, significant differences were found in relaxation (p=0.003, d=−0.744) and plank (p=0.009, d=−0.630) conditions in the IG. Significant differences were also registered in the EO muscle in the IG (all conditions: p=0.046, p=0.013, and p=0.008, respectively; d=0.464, d=−0.596, and d=−0.637, respectively). IO muscle thickness tended to increase in the CG in all conditions (p=0.044, p=0.006, and p&lt;0.001, respectively) and the EG in relaxation and plank conditions (p=0.009 and p=0.007, respectively). Within groups, the effects of Pilates practice were more significant post-intervention, with the exceptions being under the contraction condition in the deepest muscles (IO: p=0.109, d=0.083; TrA: p=0.194, d=0.062). Our hypothesis was partially confirmed because 8 weeks of Pilates practice have improved significantly the thickness of the RA and EO muscles in the IG.

Muscle ultrasound in Spondyloarthritis patients receiving biologic disease-modifying anti-rheumatic drugs early in treatment

Objective: This study evaluated muscle ultrasound in spondyloarthritis (SpA) patients receiving biologic disease-modifying anti-rheumatic drugs (b-DMARDs) early in treatment. Methods: A prospective study was conducted with 110 b-DMARD-naive SpA patients. The baseline and control muscle strength, physical performance tests, ultrasonographic muscle parameters, and disease activity scores of 67 controlled patients were examined. Results: During the follow-up period, there were significant improvements in the thickness of the gastrocnemius medialis (GM) muscle (p&lt;0.001), the length of the GM fascicle (p=0.031), the thickness of the rectus femoris (RF) muscle (p&lt;0.001), the cross-sectional area of the RF (RFCSA) muscle (p&lt;0.001), the thickness of the rectus abdominis (RA) muscle (p&lt;0.001), the thickness of the transverse abdominis (TA) muscle (p=0.004), and the thickness of the external oblique (EO) muscle (p=0.042). Besides, ASDAS-CRP scores were related to GM muscle thickness, RFCSA, and TA muscle thickness percent changes in patients whose disease activity regressed from high to moderate (respectively; p=0.030, p=0.040, p=0.002). Conclusion: Muscle ultrasound examination can show muscle mass improvement in SpA patients during treatment.

Ultrasound Evaluation of Onset Core Muscle Activity in Subjects with Non-Specific Lower Back Pain and Without Lower Back Pain: An Observational Case-Control Study.

Lower back pain (LBP) has been the leading cause of disability since 1990. Objectives: The main objective of this observational case-control study was to evaluate, using ultrasound, whether there were differences in the onset and ratio of core muscle contraction between subjects with non-specific chronic lower back pain and healthy subjects. Methods: A total of 60 participants (52% women), split between those with non-specific chronic lower back pain (n = 26) and healthy (n = 34) subjects, were recruited. Initial muscle contraction of the lateral abdominal wall, pelvic floor, lumbar multifidus, and respiratory diaphragm was measured using ultrasound. The abdominal drawing-in maneuver, contralateral arm elevation, the Valsalva maneuver, and voluntary contraction of the pelvic floor in seated and standing positions were performed. The muscle thickness of the lateral abdominal wall and lumbar multifidus and excursion of the pelvic floor and diaphragm at rest and during testing were also analyzed. Results: No differences were found between the groups in the initial contraction. Statistically significant differences were found in the following variables: diaphragm excursion (p = 0.032, r = 0.277) and lumbar multifidus ratio (p = 0.010, r = 0.333) in the standing-abdominal retraction maneuver; pelvic floor excursion (p = 0.012, r = 0.325) in the standing-contralateral arm raise; and transverse abdominis ratio (p = 0.033, r = 0.275) in the sitting-contralateral arm raise. A statistically significant interaction between the groups and body mass index was observed in resting diaphragm excursion (p = 0.018, partial eta squared = 0.096) during sitting-voluntary pelvic floor contraction. Conclusions: It cannot be concluded that there is a specific pattern of core activation in any of the groups. However, statistically significant differences were found in the contraction indexes of the lumbopelvic musculature.

Transversus Abdominis plane block to manage post operative pain in canine mastectomy

The aim of this study was to assess effectiveness of transversus abdominis plane block as part of a multimodal anaesthetic protocol in controlling perioperative nociception/ pain in dogs that underwent mammary tumour excision. The study included twelve dogs belonging to different breeds and ages. The dogs were classified according to the American Society of Anaesthetists (ASA) classification of physical status, based on their pre-anaesthetic evaluations and were divided into two groups: I and II, each with six dogs. Dogs in both groups received dexmedetomidine for premedication and diazepam-propofol for induction. Group I dogs were subjected to Transversus abdominis plane (TAP) block and Group II dogs were given butorphanol. Pain score was assessed using the Glasgow Composite Measure Pain Scale (GCMPS-SF) at one hour post-operatively. The pain score was significantly lower in Group I. None of the dogs in Group I required rescue analgesia. TAP block proved beneficial in mitigating nociception and postoperative pain in dogs undergoing mammary tumour excision. Keywords: Mammary tumour resection, TAP block, post-operative pain

Yoga, Physical Therapy and Home Exercise Effects on Chronic Low Back Pain: Pain Perception, Function, Stress, and Quality of Life in a Randomized Trial.

Low back pain is a common health problem. In this study, we investigated the effects of yoga, physical therapy (PT), and home exercise (HE) on pain perception, function, stress, and quality of life in chronic low back pain (cLBP). We randomly assigned 54 participants to three distinct treatment groups: (a) a physical therapy group (PT) who received spinal stabilization exercises (SSE) combined with local heat and transcutaneous electrical stimulation; (b) a home exercise group (HE) who received SSE as part of the home program; and (c) a yoga group who received yoga exercises. The primary outcome measures were a Visual Analog Scale (VAS) for measuring pain, and the Oswestry Disability Index (ODI) to measure function. Secondary outcome measures were the Tampa Kinesiophobia Scale (TKS), Central Sensitization Inventory (CSI), pain sensitivity (L3 and deltoid R/L PPTs), Spielberger State-Trait Anxiety Inventory (STAI), plasma cortisol and DHEA-S levels, Transversus Abdominis (TrA) muscle activation, and the Nottingham Health Profile (NHP). Assessments were conducted before and after a six-week intervention period. All three groups demonstrated improvements in pain on the VAS, function on the ODI, pain sensitivity on the L3 and deltoid R/L PPTs, CSI, anxiety on the STAI, TrA muscle activation, and quality of life on the NHP (p < .05). The PT group exhibited a more pronounced improvement on the ODI score (p < .05) than the other groups. Cortisol levels only decreased in the PT group (p < .05). The exercises did not impact DHEA-S and NHP-S parameters. Thus, all interventions resulted in decreased stress, pain intensity, pain sensitivity, central sensitization, and improved function and quality of life; there was no singularly superior approach between interventions. These findings will aid in tailoring treatment programs for managing cLBP according to individual needs.

Differences in Abdominal and Lumbar Muscle Thickness and Contractile Function Between Nulliparous, Primiparous, and Multiparous Women 6 Months Postpartum.

The purpose of this study was to evaluate the differences between primiparous and multiparous women at 6 months postpartum and nulliparous women regarding the thickness (including thickness pattern) and contractile function of the abdominal and lumbar muscles. A cross-sectional observational study of 80 women, both primiparous (n = 29) and multiparous (n = 25), as well as including nulliparous as a comparison group (n = 26), was conducted. B-mode ultrasound imaging was used for the measurement of abdominal and lumbar muscle thickness in 2 conditions (resting and activation). Moreover, the contractile function of these muscles was determined by the thickness ratio. Significant differences between groups were observed in abdominal muscle thickness. During activation, the obliques showed a lower thickness in both groups of postpartum women compared to nulliparous women, while lower values for the thickness for the transverse abdominis (TrA) were only observed in primiparous women. The thickness pattern observed in nulliparous women both in resting and in activation (internal oblique [IO] > external oblique [EO] > TrA) was also achieved among postpartum women, despite no statistical differences observed between IO and EO in these groups. No significant differences between groups were observed for contractile function, showing the TrA greater values, followed by IO and EO in both nulliparous and postpartum women. This study suggests that the thickness (and the thickness pattern) of the abdominal muscles in women at 6 months postpartum differs from nulliparous, while for the lumbar muscles, it is comparable to nulliparous. However, despite the obliques being thinner in postpartum women, the abdominal muscles are functionally competent. This is believed to be the first study to compare abdominal and lumbar muscles thickness and contractile function specifically between primiparous and multiparous women. Although at 6 months' postpartum abdominal thickness differs from nulliparous women, these muscles are functionally competent. These findings provide valuable insights for use in the development of postpartum interventions.

Abdominal Hollowing vs. Abdominal Bracing: A Scoping Review of Clinical Trials on Effectiveness for Trunk Stability and Rehabilitation.

Objectives: This scoping review explores the effectiveness of abdominal hollowing (AH) and abdominal bracing (AB) techniques in enhancing trunk stability and facilitating rehabilitation, particularly for individuals with lower back pain (LBP). Methods: The review synthesizes findings from 22 randomized controlled trials (RCTs) that assessed these techniques' impacts on muscle activation, pain reduction, and functional outcomes. Results: The results demonstrate that both techniques can significantly improve trunk stability, muscle thickness, balance, and gait. However, a notable gap exists in studies directly comparing AH and AB, raising questions about whether they are equally effective. While AH is often associated with selective activation of the transversus abdominis, AB promotes a broader co-contraction of trunk muscles, contributing to robust spinal stability. Conclusions: This review underscores the need for further research to directly compare these techniques and refine their application in clinical practice. The findings suggest that personalized rehabilitation programs incorporating both AH and AB, tailored to individual patient needs and rehabilitation goals, can be effective in managing and preventing LBP.

Ultrasound-Guided Transversus Abdominis Plane Block as an Effective Path to Reduce Opioid Consumption After Laparoscopic Bariatric Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Effective postoperative pain management is essential to the patient's recovery. The use of opioids as the primary line of pain treatment has been known to increase rates of length of stay, pulmonary complications, paralytic ileus, and nausea and vomiting. Therefore, guidelines strongly recommend alternative paths to reduce opioid consumption through multimodal analgesia, and the transversus abdominis plane block(USG-TAP) has been considered to be one of these optimistic alternatives. A comprehensive systematic search was conducted in four databases until April 2024. We only considered for this analysis randomized controlled trials that assessed the USG-TAP as part of multimodal anesthesia in patients undergoing laparoscopic bariatric surgery. Eleven studies comprising 789 patients were included in the meta-analysis. Our results showed a significant decrease in opioid consumption after the first 24h of surgery (MD - 32.02mg; 95% IC - 51.33, - 12.71; p < 0.01) and fewer patients required extra-dose of opioid (OR 0.20; 95% IC 0.07, 0.62; p < 0.01). The pain score showed to be also improved with the TAP block (MD - 0.69; 95% IC - 1.32, - 0.07; p = 0.03). No difference concerning time to deambulate, nausea and vomiting, and time of surgery was observed among the studies. This study reinforces the benefits of the use of USG-TAP block as part of multimodal analgesia in patients undergoing laparoscopic bariatric surgery.

Analysis of muscle synergies and muscle network in sling exercise rehabilitation technique

The study assessed motor control strategies across the four sling exercises of supine sling exercise (SSE), prone sling exercise (PSE), left side-lying sling exercise (LLSE), and right side-lying sling exercise (RLSE) positions base on the muscle synergies and muscle network analyses. Muscle activities of bilateral transversus abdominis (TA), rectus abdominis, multifidus (MF), and erector spinae (ES) were captured via surface electromyography. Muscle synergies were extracted through principal components analysis (PCA) and non-negative matrix factorization (NNMF). Muscle synergies number, muscle synergies complexity, muscle synergies sparseness, muscle synergies clusters and muscle networks were calculated. PCA results indicated that SSE and PSE decomposed into 2.88 ± 0.20 and 2.82 ± 0.15 synergies respectively, while the LLSE and RLSE positions decomposed into 3.76 ± 0.14 and 3.71 ± 0.11 muscle synergies, respectively, which were more complex (P = 0.00) but less sparse (P = 0.01). Muscle synergies clusters analysis indicated common muscle synergies among different sling exercises. SSE position demonstrated specific muscle synergies with a strong contribution of the bilateral TA. LLSE-specific synergy has a strong contribution of the left erector spinae (ES). The RLSE-specific synergy has significant contributions from the right ES and multifidus. Muscle networks were functionally organized, with clustering coefficient (F(1.5, 24) = 6.041, P = 0.01) and global efficiency of the undirected network (F(1.5, 24) = 6.041, P = 0.01), and betweenness-centrality of the directed network (F(2.7, 44) = 6.453, P = 0.00). Our research highlights the importance of evaluating muscle synergies and network adaptation strategies in individuals with neuromuscular disorders and developing targeted therapeutic interventions accordingly.