UNASSIGNED: Moderate-to-severe intensity pain is reported on the first day following lower abdominal surgery. No study has compared transversus abdominis plane (TAP) block with retrolaminar block (RLB) in laparoscopic inguinal hernia surgery for postoperative pain relief.
UNASSIGNED: In this prospective, randomized trial, 42 male patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18-65 years, and having a BMI <40 kg/m2 received TAP or RLB following laparoscopic inguinal hernia surgery. A standard general anesthetic technique was performed. Patients were randomized into two groups: single-shot TAP block (group I) (n = 21) or the RLB (group II) (n = 21) with bilateral 20 ml of 0.375% ropivacaine. Postoperatively, IV paracetamol 1 g was administered as rescue analgesia. Postoperative cumulative Visual Analogue Scale (VAS) score 24 hours after surgery was considered as the primary outcome.
UNASSIGNED: Postoperative cumulative VAS score at rest at 24 h, represented as mean ± S.D (95% CI), in the TAP block group was 3.54 ± 3.04 (2.16-4.93) and in the RLB group was 6.09 ± 4.83 (3.89-8.29). P value was 0.112 and VAS on movement was 7.95 ± 3.41 (6.39-9.50 [2.5-15.0]) in TAP block group, whereas P value was 0.110 and VAS on movement was 10.83 ± 5.51 (8.32-13.34) in the RLB group.
UNASSIGNED: Similar postoperative cumulative pain score on movement at 24 h was present in patients receiving TAP block or RLB. However, VAS score at rest and on movement was reduced in patients receiving TAP block at 18 and 24 h postoperatively.

Transversus abdominis release (TAR) is a myofascial release technique which helps in surgical repair of large ventral abdominal wall defects. In this procedure, the medial margin of muscular part of transversus abdominis (TA) is of great importance. Hence, the authors sought to describe the extent of medial margin of TA muscle. The surgical steps of TAR were performed in 10 formalin-fixed cadavers and distance between medial margin of TA muscle, lateral margin of rectus abdominis, to linea alba at five anatomical levels were documented respectively. The distance between the inferior epigastric vessels and the medial border of TA muscle was also noted. The TA muscle was within the posterior rectus sheath in all cadavers, at the xiphisternum (R, 61.6 mm; L, 58.9 mm), and at midway between xiphisternum and umbilicus (R, 25.4 mm; L, 27.1 mm). The TA muscle exited the posterior rectus sheath between this point and the umbilicus. The mean incongruity at the next three levels were -24.6 mm, -24.9 mm, and -22.9 mm respectively on the right and -21.4 mm, -19.9 mm, and -18.9 mm respectively on the left. The mean distance between the medial border of TA and inferior epigastric vessels was 18.9 mm on the right and 17.2 mm on the left. The muscular part of TA was incorporated within the posterior rectus sheath above the umbilicus, and it completely exited the rectus sheath at the umbilicus. This is contrary to the traditional understanding of posterior rectus sheath formation.

To investigate the effects of intentionally minimizing spinal motion and abdominal muscle contractions on intervertebral angles during quadruped upper and lower extremity lift (QULEL). Fifteen healthy men performed the QULEL under four conditions: without any special instructions (basic), with the intention to minimize spinal motion (intentional), with abdominal bracing (bracing), and with abdominal hollowing (hollowing). Each intervertebral angle was calculated from the local coordinate system using the marker data obtained from a motion capture system. Shear moduli, as indicators of the activities of the right transversus abdominis (TrA), internal and external oblique, and rectus abdominis muscles, were assessed using shear wave elastography during QULEL. One-way repeated-measures analysis of variance and multiple comparisons among conditions were used to compare each shear modulus of the abdominal muscle and the changes in thoracic kyphosis (Th1-12), lumbar lordosis (L1-5), and lumbar intervertebral angles from the quadruped position to QULEL. The significance level was set at P < 0.05. Changes in lumbar lordosis and L2/L3 and L3/L4 extension angles were significantly lower under hollowing than under other conditions (effect size ηG2: lumbar lordosis, 0.068; L2/L3, 0.072; L3/L4, 0.043). The change in the L1/L2 extension angle significantly decreased in bracing and hollowing compared with the basic (ηG2 = 0.070). Only the TrA shear modulus significantly increased in bracing and hollowing compared with the basic (ηG2 = 0.146). Abdominal hollowing during the QULEL increased TrA activity and suppressed lumbar extension, except at L4/L5, and may be more effective as a rehabilitation exercise for controlling spinal motion.

Background: Patellofemoral osteoarthritis (PF OA) is exceptionally predominant and limiting. However, little is known about the risk factors that contribute to its onset and progression. Purpose: The aim of this study was to decide if women with PF OA descend stairs using different muscular activation strategies compared to similarly aged healthy controls. Methods: Thirty-one women with isolated PF OA and 11 similarly aged healthy women took part in this study. The activation onset and duration of PF OA in vastus medialis oblique (VMO), vastus lateralis (VL), gluteus medius (GM), transversus abdominis (TrA), and multifidus muscles were evaluated during the stair descent task using surface electromyography (EMG). Results: There was a non-significant difference between women with PF OA and healthy controls regarding all tested variables, except for the GM activation onset that was significantly delayed in women with PF OA, with the p-value of 0.011. Conclusion: The causes of PF OA differ and might not always be due to a lack of quadriceps strength or VMO activation deficiency, and prospective longitudinal studies are required to confirm this assumption.

OBJECTIVE: To clarify the association between forced expiration and the abdominal muscles by assessing the relationship between expiratory mouth pressure and abdominal muscle activity in healthy young males.
METHODS: Twenty-five males underwent forced expiration at 20, 30, 50, 75, and 100% of the maximal expiratory mouth pressure. Mouth pressure was measured using a bridge-type transducer connected to a mouth pressure meter. Abdominal crunch, twist crunch, and abdominal hollowing at maximal voluntary contraction were also performed. During forced expiration and abdominal exercises, the activity of the rectus abdominis (RA), oblique externus abdominis/oblique internus abdominis (OE/OI), and OI/transversus abdominis (OI/TrA) was measured using surface electromyography.
RESULTS: The determination coefficient (r2) for the linear relationship between mouth pressure and abdominal muscle activity was 0.86 ± 0.15 for the RA, 0.93 ± 0.06 for the OE/OI, and 0.90 ± 0.14 for the OE/OI. The slope of the linear relationship with r2 ≥ 0.50 showed no significant difference between the RA (0.22 ± 0.27) and the OE/OI (0.27 ± 0.21). However, it was significantly greater in the OI/TrA (1.78 ± 1.41) than in the RA and OE/OI. The OE/OI activity was significantly lower in the maximal forced expiration than in twist crunch, and the OI/TrA activity was not significantly greater in the maximal forced expiration than in twist crunch.
CONCLUSIONS: All abdominal muscles contribute to forced expiration with a greater contribution of the OI and TrA than the RA and OE. Furthermore, the contribution of the TrA would be greater than that of the OI.

UNASSIGNED: To determine feasibility of a randomized controlled trial (RCT) comparing postpartum rectus abdominis training with transversus abdominis training in reducing the inter-recti distance in patients with diastasis of the rectus abdominis muscles (DRAM).
UNASSIGNED: A pilot, randomized controlled trial with longitudinal assessment following vaginal delivery at 6 and 12 weeks postpartum was completed. Forty-four women with DRAM (inter-recti distance of ≥ 30mm as measured by digital calipers) were recruited from a regional public hospital in Australia. The standard treatment group (n = 21) was provided with a 5-second transversus abdominis activation exercise in crook lying. The experimental group (n = 23) was provided with a 1-second rectus abdominis crunch exercise. Dosage was between 1-10 repetitions at baseline and between 1-20 at 6 weeks, twice a day, at least 5 days per week, prescribed depending on individual participant ability. The primary outcome measure was inter-recti distance. Feasibility measures were recruitment rate, loss to follow-up, adverse events, and exercise adherence.
UNASSIGNED: The rectus abdominis group achieved greater reduction of the inter-recti distance at 6 weeks (at and below the umbilicus) and 12 weeks (above, below, and at the umbilicus). Recruitment rate was acceptable (45%) and there were no adverse events, but loss to follow-up was high due to COVID-19 impacts and participants did not return exercise adherence diaries.
UNASSIGNED: Prescription of rectus abdominis exercise during the early postpartum period following vaginal delivery resulted in a greater reduction of the inter-recti distance at 6 and 12 weeks when compared with transversus abdominis exercise. This pilot trial was impacted by high loss to follow up due to COVID-19 restrictions, but feasibility was otherwise acceptable. The findings of the study will inform future fully powered trials comparing these two exercise types in postpartum women with DRAM.
UNASSIGNED: déterminer la faisabilité d’une étude randomisée et contrôlée pour comparer l’entraînement des grands droits à l’entraînement des muscles transverses afin de réduire la distance intermusculaire chez les patientes ayant une diastase des grands droits (DGD).
UNASSIGNED: étude pilote randomisée et contrôlée comportant une évaluation longitudinale six et 12 semaines après un accouchement vaginal. Au total, 44 femmes ayant une DGD (distance intermusculaire d’au moins 30 mm, mesurée à l’aide d’une règle à coulisse numérique) ont été recrutées dans un hôpital régional public de l’Australie. Le groupe sous traitement standard (n = 21) a reçu un exercice d’activation des muscles transverses de cinq secondes en position allongée sur le dos, les genoux pliés. Le groupe expérimental (n = 23) a reçu un exercice de demi-redressement assis des grands droits d’une seconde. La posologie de une à dix répétitions pour commencer et de une à 20 répétitions deux fois par jour la sixième semaine, au moins cinq jours par semaine, dépendait de la capacité de chaque participante. La mesure d’issue primaire était la distance entre les muscles. Les mesures de faisabilité étaient le taux de recrutement, la perte au suivi, les événements indésirables et l’adhésion aux exercices.
UNASSIGNED: le groupe d’exercices des grands droits a réduit davantage la distance entre les muscles au bout de six semaines (à l’ombilic et sous l’ombilic) et de 12 semaines (au-dessus et au-dessous de l’ombilic et à l’ombilic). Le taux de recrutement était acceptable (45 %) et il n’y avait pas d’événements indésirables, mais la perte au suivi était élevée à cause des conséquences de la COVID-19, et les participantes n’ont pas remis leur journal d’adhésion aux exercices.
UNASSIGNED: la prescription d’exercices des grands droits au début de la période postnatale après un accouchement vaginal favorisait une plus grande réduction de la distance entre les grands droits au bout de six et 12 semaines que les exercices des muscles transverses. L’étude pilote a été touchée par une forte perte au suivi à cause des restrictions liées à la COVID-19, mais la faisabilité était autrement acceptable. Les résultats de l’étude éclaireront de futures études comportant un plein échantillonnage pour comparer deux types d’exercices postnatals chez des femmes présentant une diastase des grands droits.

The transversus abdominis (TrA) is a core muscle that contributes to functional mobility and lumbar stability. This study aimed to compare the changes in TrA thickness during different Pilates exercises, and to identify the exercise that elicited the greatest TrA activation. Forty-four healthy women were divided into two groups: young (25-35 years old) and middle-aged (36-55 years old). TrA thickness was assessed by ultrasound while the participants performed five Pilates exercises: basic position, hundred, hip roll, side plank, and dead bug. A repeated measures analysis of variance revealed that the dead bug exercise induced a significantly higher increase in TrA thickness (relative to rest) than the other exercises (p < 0.05). The young group also showed a significantly higher overall TrA thickness than the middle-aged group (p < 0.05). The findings suggest that the dead bug exercise is the most effective for enhancing TrA activation among the Pilates exercises tested. The basic position and the hundred exercises can be used as warm-up exercises before performing more challenging exercises such as the hip roll, the side plank, and the dead bug. The sequence of exercises can be similar for both young and middle-aged women.

OBJECTIVE: The aim of our study is to examine the changes in core muscle functions during pregnancy.
METHODS: Our study was carried out in 67 primigravida pregnant women. Superficial electromyography (EMG) and non-invasive 2D/3D ultrasonography (USG) were used to evaluate core muscle (diaphragm, transversus abdominus [TA], internal oblique [IO]-external oblique [EO] muscles, pelvic floor muscles, multifidus) function during pregnancy. Pelvic floor muscle strength was also measured by a digital palpation method (PERFECT system). USG was used to measure expected fetal weight and the diastasis recti (DR) distance. Mann-Whitney U test was used to show changes in trimesters in the core muscles, and Spearman correlation analysis was used to determine the relationship.
RESULTS: In the third trimester, an nonsignificant increase in EMG parameters was observed in all of the core muscles. Although a statistically significant decrease was observed in muscle thickness values measured by EO and IO USG in the third trimester, DR was found to increase at all levels (p < 0.005). When we evaluated both trimesters and all pregnant women together, no relationship was found between all core muscles and pelvic floor muscles in the data evaluated by EMG and USG. We found a negative correlation in USG values between fetal weight and IO and the upper part of the rectus abdominus muscle, and a positive correlation between the EMG data of the EO and rectus abdominus muscles.
CONCLUSIONS: In women, the coactivation relationship between the core muscles may disappear during pregnancy. As the trimesters progress during pregnancy, a decrease in thickness and an increase in muscle activity can be observed in the core muscles. Pregnant women can be given exercise training for core muscles for protection in both the prenatal and postnatal periods. But more research needs to be done.

This study aimed to investigate the effectiveness of 3D postural correction (3DPC) using corrective cushions (CCs) and abdominal muscle contraction (AMC) on the thickness symmetry of the transversus abdominis (TrA) and spinal alignment in patients with idiopathic scoliosis (IS). In the first experiment, ultrasound measurements were taken of the TrA thickness on both the convex and concave sides of the lumbar curve in the supine position during AMC and non-AMC without 3DPC, and during AMC and non-AMC with 3DPC using CCs, in 11 IS patients. In the second experiment, 37 IS patients participated in a four-week 3DPC exercise program that aimed to maintain TrA thickness symmetry based on the results of the first experiment. The study found that TrA thickness symmetry significantly increased after 3DPC using CCs and combined with AMC (p < 0.05). Additionally, the Cobb angles and trunk rotation angles showed significant decreases, and trunk expansion showed a significant increase (p < 0.05). These results indicate that the simultaneous application of 3DPC and AMC is the most effective way to achieve TrA thickness symmetry in IS patients. Therefore, 3DPC and AMC should be considered as crucial elements in exercise interventions for IS patients.

The Transversus Abdominis Plane (TAP) block is a regional abdominal wall block that has been effectively used as an adjunct to alleviate postoperative pain. The ultrasound-guided TAP (USTAP) administered by anesthesiologists is the gold standard and has been effective for surgeries involving abdominal wall incisions. Recently, the TAP block has been administered by surgeons with the help of direct visualization during minimally invasive surgery. The surgeon-administered or laparoscopic-guided TAP block has been compared to the USTAP with no discernible difference in patient outcomes. Also, directly visualizing the injection in the surgeon-administered block can offset complications such as visceral injury and block failure (injectate in the wrong plane). This review explores the literature\'s surgeon-administered TAP blocks for minimally invasive surgery in the literature. In addition, the prerequisite anatomy of the anterolateral abdominal wall, various approaches, and other factors that influence the efficacy of the block are described to increase awareness of this analgesic tool among surgeons and achieve better postoperative pain management.