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Current Pain and Headache Reports Oct 2023The purpose of this review is to provide an up-to-date description and overview of the rapidly growing literature pertaining to techniques and clinical applications of... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to provide an up-to-date description and overview of the rapidly growing literature pertaining to techniques and clinical applications of chest wall and abdominal fascial plane blocks in managing perioperative pain.
RECENT FINDINGS
Clinical evidence suggests that regional anesthesia blocks, including fascial plane blocks, such as pectoralis, serratus, erector spinae, transversus abdominis, and quadratus lumborum blocks, are effective in providing analgesia for various surgical procedures and have more desirable side effect profile when compared to traditional neuraxial techniques. They offer advantages such as reduced opioid consumption, improved pain control, and decreased opioid-related side effects. Further research is needed to establish optimal techniques and indications for these blocks. Presently, they are a vital instrument in a gamut of multimodal analgesia options, especially when there are contraindications to neuraxial or para-neuraxial procedures. Ultimately, clinical judgment and provider skill set determine which blocks-alone or in combination-should be offered to any patient.
Topics: Humans; Thoracic Wall; Analgesics, Opioid; Pain, Postoperative; Abdominal Muscles; Abdomen
PubMed: 37624474
DOI: 10.1007/s11916-023-01158-7 -
Journal of Gastrointestinal Surgery :... Dec 2023Understanding anorectal and pelvic floor anatomy can be challenging but is paramount for every physician managing patients with anorectal pathology. Knowledge of... (Review)
Review
Understanding anorectal and pelvic floor anatomy can be challenging but is paramount for every physician managing patients with anorectal pathology. Knowledge of anorectal anatomy is essential for managing benign, malignant, traumatic, and infectious diseases affecting the anorectum. This quiz is intended to provide a practical teaching guide for medical students, medical and surgical residents, and may serve as a review for practicing general surgeons and specialists.
Topics: Humans; Rectum; Pelvic Floor; Anal Canal
PubMed: 38135807
DOI: 10.1007/s11605-023-05862-y -
The Surgical Clinics of North America Oct 2023This article provides an approach to open complex abdominal wall reconstruction. Herein, the authors discuss the purpose of component separation as well as its relevant... (Review)
Review
This article provides an approach to open complex abdominal wall reconstruction. Herein, the authors discuss the purpose of component separation as well as its relevant indications. The techniques and anatomical considerations of both anterior and posterior component separation are described. In addition, patient selection criteria, preoperative adjuncts that may assist with fascial or soft tissue closure, and complications of component separation will be discussed.
Topics: Humans; Abdominal Muscles; Abdominal Wall; Hernia, Ventral; Fascia; Patient Selection
PubMed: 37709399
DOI: 10.1016/j.suc.2023.04.006 -
International Urogynecology Journal Nov 2023The aim of our study is to examine the changes in core muscle functions during pregnancy.
INTRODUCTION AND HYPOTHESIS
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.
Topics: Humans; Female; Pregnancy; Fetal Weight; Abdominal Muscles; Electromyography; Exercise; Exercise Therapy; Diastasis, Muscle
PubMed: 37417993
DOI: 10.1007/s00192-023-05597-z -
Clinics in Plastic Surgery Jan 2024Abdominoplasty has evolved in the last few decades, especially the treatment of the myoaponeurotic deformities. Bulging, lack of definition of the abdominal contour,... (Review)
Review
Abdominoplasty has evolved in the last few decades, especially the treatment of the myoaponeurotic deformities. Bulging, lack of definition of the abdominal contour, should be understood and treated according to the individual deformity. Many types of deformities have been recognized and treatment respects the local anatomy in most cases. Scientific basis that consolidate these treatments are discussed as well as possible recurrences and pitfalls of these techniques. The histological composition of muscles and fascia are also discussed and anatomical details help to enrich the knowledge of the correction of this layer. Specific types of sutures are suggested for both plications and muscle advancement.
Topics: Humans; Abdominoplasty; Abdominal Muscles; Plastic Surgery Procedures; Sutures; Suture Techniques
PubMed: 37945076
DOI: 10.1016/j.cps.2023.07.007 -
Journal of Ultrasound in Medicine :... Sep 2023Lumbopelvic pain (LPP) is a very common cause of discomfort during pregnancy, but its etiology remains unclear. The association between abdominal muscle thickness and...
OBJECTIVES
Lumbopelvic pain (LPP) is a very common cause of discomfort during pregnancy, but its etiology remains unclear. The association between abdominal muscle thickness and LPP in pregnant women has not been studied extensively, despite the significant abdominal changes that occur during pregnancy. This study aimed to examine the relationship between abdominal muscle thickness and LPP in pregnant women.
METHODS
In this study, 49 pregnant women in their second trimester participated. The intensity of LPP was assessed using a numerical rating scale. Ultrasound imaging was used to measure the thickness of abdominal muscles, including the rectus abdominis, external oblique, internal oblique, and transversus abdominis muscles. Participants were classified into two groups, the LPP group and non-LPP group, and the abdominal muscle thickness was compared between the two groups. The statistical significance level was set at P < .05.
RESULTS
There were 24 and 25 participants in the LPP and non-LPP groups, respectively. Internal oblique (IO) thickness was significantly thinner in the LPP group than in the non-LPP group (5.4 ± 0.2 mm versus 6.1 ± 0.2 mm; P = .042). Multivariate logistic regression analysis showed that IO thickness was significantly associated with LPP (odds ratio, 0.516; 95% confidence interval, 0.284-0.935; P = .019).
CONCLUSIONS
This study suggested that LPP in second trimester pregnancy might be related to IO thickness. Further longitudinal studies are needed to understand the role of this muscle as an LPP risk factor for pregnant women.
Topics: Female; Humans; Pregnancy; Pregnant Women; Low Back Pain; Abdominal Muscles; Ultrasonography; Rectus Abdominis
PubMed: 37079609
DOI: 10.1002/jum.16232 -
Surgical Endoscopy Dec 2023Tension-free abdominal closure is a primary tenet of laparotomy. But this concept neglects the baseline tension of the abdominal wall. Ideally, abdominal closure should...
BACKGROUND
Tension-free abdominal closure is a primary tenet of laparotomy. But this concept neglects the baseline tension of the abdominal wall. Ideally, abdominal closure should be tailored to restore native physiologic tension. We sought to quantify the tension needed to re-establish the linea alba in patients undergoing exploratory laparotomy.
METHODS
Patients without ventral hernias undergoing laparotomy at a single institution were enrolled from December 2021 to September 2022. Patients who had undergone prior laparotomy were included. Exclusion criteria included prior incisional hernia repair, presence of an ostomy, large-volume ascites, and large intra-abdominal tumors. After laparotomy, a sterilizable tensiometer measured the quantitative tension needed to bring the fascial edge to the midline. Outcomes included the force needed to bring the fascial edge to the midline and the association of BMI, incision length, and prior lateral incisions on abdominal wall tension.
RESULTS
This study included 86 patients, for a total of 172 measurements (right and left for each patient). Median patient BMI was 26.4 kg/m (IQR 22.9;31.5), and median incision length was 17.0 cm (IQR 14;20). Mean tension needed to bring the myofascial edge to the midline was 0.97 lbs. (SD 1.03). Mixed-effect multivariable regression modeling found that increasing BMI and greater incision length were associated with higher abdominal wall tension (coefficient 0.04, 95% CI [0.01,0.07]; p = 0.004, coefficient 0.04, 95% CI [0.01,0.07]; p = 0.006, respectively).
CONCLUSION
In patients undergoing laparotomy, the tension needed to re-establish the linea alba is approximately 1.94 lbs. A quantitative understanding of baseline abdominal wall tension may help surgeons tailor abdominal closure in complex scenarios, including ventral hernia repairs and open or burst abdomens.
Topics: Humans; Abdominal Wall; Hernia, Ventral; Abdominal Muscles; Laparotomy; Fascia; Surgical Wound
PubMed: 37640951
DOI: 10.1007/s00464-023-10346-w -
The Journal of Obstetrics and... Feb 2024The main objective of this review was to develop strategies for individualizing multidisciplinary therapy for vulvodynia. (Review)
Review
OBJECTIVE
The main objective of this review was to develop strategies for individualizing multidisciplinary therapy for vulvodynia.
METHODS
We conducted two literature searches; the first one focused on clinical trials assessing vulvodynia treatments published after the recommendations of the expert committee of the Fourth International Consultation on Sexual Medicine. The second search targeted studies identifying predictive factors and mediators of vulvodynia treatments, published from the earliest date to October 2022.
RESULTS
Based on data from 55 relevant studies, we developed models of individualized multidisciplinary therapy targeting groups of women less responsive to multidisciplinary therapy (characterized by women with higher vulvar pain intensity, impaired sexual functioning, and vulvodynia secondary subtype) and to physical therapy, as an isolated treatment (characterized by women with increased pelvic floor muscle tone and vulvodynia primary subtype). Each individualized multidisciplinary therapy model comprises three components: psychotherapy, medical care, and physical therapy. These components provide distinct therapeutic modalities for distinct subgroups of women with vulvodynia; the women subgroups were identified according to the characteristics of women, the disease, partners, and relationships. Additionally, for women with provoked vestibulodynia who exhibit less benefits from vestibulectomy (such as those with higher levels of erotophobia, greater vulvar pain intensity, and the primary subtype) and encounter resistance to individualized multidisciplinary therapy, we suggest additional conservative treatments before performing vestibulectomy.
CONCLUSION
Our study is a pioneer in the development of models that allow the individualization of multidisciplinary therapy for vulvodynia and represents a significant advance in the clinical practice of gynecologists, physiotherapists, and psychologists.
Topics: Female; Humans; Vulvodynia; Physical Therapy Modalities; Pelvic Floor; Referral and Consultation
PubMed: 37968775
DOI: 10.1111/jog.15829 -
Sports Health Nov 2023Core musculature is important for efficiency during activities including running. Both abdominal muscle strength and endurance contribute to this efficiency. The purpose...
BACKGROUND
Core musculature is important for efficiency during activities including running. Both abdominal muscle strength and endurance contribute to this efficiency. The purpose of this study is to determine what differences and relationships exist in abdominal muscle thickness, strength, and endurance among persons who are runners, active, and inactive.
HYPOTHESIS
Persons in the running group would show significantly greater abdominal muscle thickness, muscle strength, and muscle endurance compared with those in the nonrunning groups.
STUDY DESIGN
Quantitative cohort design.
LEVEL OF EVIDENCE
Level 2b.
METHODS
A total of 78 subjects aged 18 to 27 years were divided into 3 groups: runners, active, and inactive. Assessment included abdominal muscle thickness via diagnostic ultrasound (Mindray North America), strength using a static Isotrack dynamometer (JTech Medical), and abdominal muscle endurance using a side plank. Statistical analysis using analysis of variance, tests, and Pearson's correlation coefficients and partial correlations was performed using SPSS Version 26 with a significance level of < 0.05.
RESULTS
Significantly greater muscle thickness of internal obliques (IOs) at rest and during contraction was found in the running group compared with the active group, the active group compared with the inactive group, and the running group compared with the inactive group. There were no statistically significant differences in overall strength measured by dynamometry among the 3 groups. Plank time was significantly greater for the running group compared with the other 2 groups. Male participants were greater in all areas: strength, plank time as a measure of muscle endurance, and muscle thickness. Body mass index was significantly correlated with resting thickness, muscle endurance, and muscle strength.
CONCLUSION
Persons who run, are active, and are inactive use their abdominal muscles differently. Runners have thicker IOs and better abdominal muscle endurance than the other 2 groups. Focusing on endurance training of the obliques may be beneficial for persons who run.
CLINICAL RELEVANCE
This research could contribute to developing core training programs to ensure runners target the correct abdominal muscles with the best type of training.
PubMed: 37982403
DOI: 10.1177/19417381231212471 -
Clinics in Plastic Surgery Jan 2024There is a continuous search for better technical alternatives for the treatment of abdominal contour deformities in the practice of plastic surgeons.... (Review)
Review
There is a continuous search for better technical alternatives for the treatment of abdominal contour deformities in the practice of plastic surgeons. LADE-lipoabdominoplasty (LAP) with anatomical definition-is a step ahead of the traditional LAP technique. This technique incorporated the principles of highlighting the definition of the abdominal musculature, achieving more natural results with fewer reminders of a surgical intervention. The esthetic results are much harmonious, with a true abdominal rejuvenated appearance. We can reduce morbidity by the preservation of perforating blood vessels and suspension of Scarpa's fascia. The correct selection of the patient makes the procedure safe and reproducible.
Topics: Humans; Lipoabdominoplasty; Abdominoplasty; Lipectomy; Abdominal Muscles; Adipose Tissue
PubMed: 37945075
DOI: 10.1016/j.cps.2023.06.011