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Case 2.15
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
This is a procedure popularized by Ramirez to increase the potential for direct closure of the abdomen with possible medial advancement of 3–5 cm per side. It is achieved by division of the external oblique aponeurosis which allows medialization of the rectus/internal oblique/transversus abdominis muscle complex. Release of the rectus muscle from its posterior sheath provides an additional 2 cm of advancement.
The Gallbladder (GB)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Transversus abdominis muscle: Compresses and supports the abdominal viscera. Since this is the deepest layer of the muscles of the abdominal wall, needling through this muscle may damage internal organs.
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.
Rehabilitation of a patient with bilateral rectus abdominis full thickness tear sustained in recreational strength training: a case report
Published in Physiotherapy Theory and Practice, 2022
Omer B. Gozubuyuk, Ceylan Koksal, Esin N. Tasdemir
US also enables the clinician to assess the injured muscle’s contractility, compared with the contralateral side, and follow-up effectively We utilized the US initially to aid outlining the extent of the soft tissue dysfunction, by showing the contractibility of the injured muscle. Secondly, during the first phase, we used real-time US feedback to the patient, depicting the latency and ability of the transversus abdominis contraction during abdominal hollowing. It has been shown that using US feedback, healthy subjects needed fewer sessions to learn motor activation of the transversus abdominis muscle (Henry and Westervelt, 2005). The patient had great success in learning to activate the deep musculature using real-time feedback, and this ability was maintained throughout the rehabilitation. One of the follow-up cine images of abdominal hollowing without verbal feedback can be seen in Video 6.
Comparison of transversus abdominis plane blocks with liposomal bupivacaine versus ropivacaine in open total abdominal hysterectomy
Published in Baylor University Medical Center Proceedings, 2022
John C. Alexander, Mary Sunna, YPaul Goldenmerry, Allison Mootz, Caitlin O’Connor, Jenny Ringqvist, Matthew Bunker, Girish P. Joshi, Irina Gasanova
Ultrasound-guided bilateral TAP blocks were performed at the conclusion of surgery but prior to emergence from general anesthesia. With the patient in a supine position on the operative table, a linear ultrasound probe was placed on the anterolateral abdominal wall between the costal margin and the iliac crest and manipulated to allow observation of the three muscle layers of the abdominal wall: external oblique muscle, internal oblique muscle, and transversus abdominis muscle. Then, a 21-gauge, 100-mm Pajunk block needle was advanced in plane under direct ultrasound visualization until the needle tip was observed in the fascial plane between the internal oblique muscle and transversus abdominis muscle. At this point, 20 mL of local anesthetic was injected incrementally and with frequent negative aspiration to avoid intravascular injection into the plane between the two aforementioned muscles. The contralateral TAP block was performed in the exact same fashion. For the oldest cases assessed, the local anesthetic utilized was 0.5% ropivacaine. When liposomal bupivacaine was added to the formulary of the institution’s community hospital for use in fascial plane blocks, the regional anesthesia service changed its practice to utilize 10 mL liposomal bupivacaine (133 mg) mixed with 10 mL 0.25% bupivacaine in a single syringe. Thus, patients in the ropivacaine group received a total of 40 mL 0.5% ropivacaine for bilateral TAP blocks, and patients in the liposomal bupivacaine group received a total of 20 mL liposomal bupivacaine (266 mg) and 20 mL 0.25% bupivacaine for bilateral TAP blocks.