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Caesarean Section
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
One should add parenteral analgesia with an opioid, for example, morphine or fentanyl, to relieve pain in the postoperative period. At the same time, the use of parenteral analgesics should be kept to minimal as she must be wakeful to feed and nurse the neonate. One can use nonsteroidal anti-inflammatory drugs like diclofenac or ketorolac, or paracetamol. The choice of the drug depends on the patient preference, allergies, and side effects. Transversus abdominis plane block is found to give substantial pain relief.
Trunk Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Rowan Sherwood
Transversus abdominis may be absent in rare cases (Macalister 1875; Rickenbacher et al. 1985; Bergman et al. 1988; Saga and Takahashi 2016; Standring 2016). It may also be doubled (Macalister 1875). The attachments of transversus abdominis to the ribs can vary in number, generally ranging from five attachments to seven attachments (Macalister 1875; Knott 1883b; Bergman et al. 1988). Transversus abdominis can be fused with internal oblique (Macalister 1875; Knott 1883b; Standring 2016). A tendinous intersection may be present (Macalister 1875). The spermatic cord may travel through the inferior portion of transversus abdominis (Macalister 1875; Knott 1883b; Saga and Takahashi 2016). There are variations in how the aponeurosis of transversus abdominis contributes to the rectus sheath (see the entry for obliquus internus abdominis for prevalence information).
Rives-Stoppa Repair and Peritoneal Flap Hernioplasty
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
The inability to close the anterior fascia at this stage of the operation is usually a reflection of poor case selection, poor pre-operative planning, or both; fortunately this is unusual if posterior closure has been achieved. Start by reconstituting the normal linea alba in the midline away from any hernia defects, where it was opened at the start as these layers clearly ‘belong’ together aided by interrupted figure-of-eight sutures to help pull the separated fascia together. This becomes a balance between some controlled tension to achieve fascial apposition and avoiding too much tension which will lead to wound dehiscence. Consideration can be given to performing an anterior component separation (see Chapter 10) on one or both sides to provide the necessary mobilisation, and this may be performed endoscopically to minimise the risks to the periumbilical skin perforators. A transversus abdominis release is not recommended as this will require removal of the mesh, extension of the retro-muscular dissection and placement of an even larger mesh.
Transversus abdominis plane block versus paravertebral block for post-operative pain following open renal surgeries: A randomized clinical trial
Published in Egyptian Journal of Anaesthesia, 2022
Khaled Abdel-Baky Abdelrahman, Essam Ezzat Abdelhakeem, Abdel-Rahman Hussein Ali, Eman Ahmed Ismail
This block was done by using SonoSite M Turbo (USA) with linear multi-frequency 6–13 MHz transducer (L25x6–13 MHz linear array) scanning probe and 21 G Toughy needle which used to inject the local anesthetic agent into the TAP space. The block was done for the patients in the supine position and before performing the supposed surgery for them. The ultrasound probe was placed just below the costal margin and parallel to it. The rectus abdominis muscle appeared and the transversus abdominis muscle posterior to it. The transversus abdominis plane (TAP) appeared as hyperechoic line just posterior to the skin and the subcutaneous tissue. The needle then placed in-plane of the probe and advanced from medial to lateral until reached the TAP space. Then, 20 ml of 0.5% plain bupivacaine (Sunnypivacaine®, Sunny pharmaceuticals, Egypt) was injected in the TAP space. The muscle layers appeared separating from each other which indicated the correct injection of the local anesthetic in the TAP space. After this nerve block had been performed in every patient in this group, the patient then was turned to lateral decubitus position and the site of surgery was cleaned and sterilized with povidone iodine and the patient was draped with sterile drapes and the supposed surgery was performed [8]. Before the end of the surgery, 1 gm IV paracetamol was given for all patients. Upon completion of surgery and reversal of the muscle relaxants, patients were extubated and sent to the recovery room and later to the ward.
Outpatient colectomy—a dream or reality?
Published in Baylor University Medical Center Proceedings, 2022
Stephen Campbell, Alessandro Fichera, Scott Thomas, Harry Papaconstantinou, Rahila Essani
Same-day colectomy should be limited to minimally invasive surgery. The cases described here were all performed robotically. Consideration should be given to intracorporeal anastomosis creation if feasible. These cases should be done as the first case of the day to allow time for observation by the surgical team prior to discharge. The Foley catheter should be removed prior to extubation to maximize the time available for spontaneous voiding while the patient is in recovery. A transversus abdominis plane block can be performed intraoperatively or postoperatively by the anesthesia pain management team.7,8 In our patients, the blocks were performed postoperatively in the postanesthesia care unit. We followed our standard intraoperative ERAS guidelines for our case series. Additionally, these cases should be scheduled early in the week (Monday to Wednesday) to allow for close follow-up in clinic during the same week.
The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial
Published in Physiotherapy Theory and Practice, 2021
Nadia Keshwani, Sunita Mathur, Linda McLean
Physiotherapeutic interventions for DrA typically include exercise therapy and/or abdominal binders (Keeler et al., 2012). A wide range of abdominal exercises are prescribed (Keeler et al., 2012; Litos, 2014), with a pervasive focus on transversus abdominis muscle activation (Keeler et al., 2012). Such exercises have theoretical merit as the connective tissue sheaths surrounding the muscles of the lateral abdominal wall are continuous with the linea alba (Rizk, 1980). As such, activation of the muscles of the lateral abdominal wall, including the transversus abdominis, can mechanically load the linea alba (Lee and Hodges, 2016; Scott-Conner and Dawson, 2009). Mechanical loading may stimulate the formation and alignment of collagen (Buckwalter and Grodzinsky, 1997; Kjaer et al., 2009), thereby enhancing the capacity of the linea alba to transfer loads across the midline. Although this hypothesis remains unconfirmed, abdominal exercises performed in the post-partum period may improve the mechanical function of the linea alba.