Access to abdominal cavity - open
P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams in Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
The most superficial layer is the skin. Immediately under the skin is the subcutaneous layer, consisting mainly of fat with areas of condensation called Camper’s (superficial) and Scarpa’s (deep) fascia, respectively. The most superficial muscle is the external oblique muscle. Its aponeurosis is well defined medially, while the muscle itself lies more laterally. Its fibers run obliquely in the direction outlined by slipping a hand in a pocket. The internal oblique muscle lies immediately under the external oblique muscle, and its fibers run at 90° with those of the external oblique muscle. The transverse abdominal muscle lies deep to the internal oblique muscle. Its fibers run transversely.
Abdomen
Bobby Krishnachetty, Abdul Syed, Harriet Scott in Applied Anatomy for the FRCA, 2020
With the patient in the supine position, a linear probe is placed just above umbilicus in the transverse plane. The linea alba is identified in the midline with the two rectus muscles either side. Scanning laterally, the semilunaris is identified on the lateral border of the rectus with the external oblique, internal oblique and transversus abdominis muscle layers seen further laterally. After identifying the rectus muscles, the anterior and posterior portions of the rectus sheath and the peritoneum (a hyperechoic line beneath the posterior rectus sheath), an in-plane approach is used.
The Gallbladder (GB)
Narda G. Robinson in 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.
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.
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.
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