Objectives: Improving the timing and endurance of the deep abdominal muscles, notably TRANSVERSUS ABDOMINIS (TrA), is a known protocol for improving spinal stability. TrA is the deepest abdominal muscle, and monitoring its activity is a difficult task. Ultrasound and pressure biofeedback have been employed for monitoring the activity of TrA,however, these methods are expensive, not always available in all clinical settings, and their application requires formal training. The purpose of this study was to examine the use of a broadly known method, i. e., changes in the waist circumference, to monitor the activity of TrA. Methods: The study was carried out on 14 subjects following a pilot study of 5 participants. The thickness of TrA measured by ultrasound was considered the standard indicator for activity of TrA and was compared with simultaneous measurement of waist circumference. Results: A significant criterion validity between the thickness of TrA and the waist circumference was established (Pearson correlation=-0. 71, P=0. 001), indicating an inverse relationship between changes in the thickness of the TRANSVERSUS ABDOMINIS muscle and waist circumference. Discussion: This result confirmed the hypothesis that changes in the waist circumference could be employed as a suitable indicator for the activity of TrA.

Background: Pain control after surgery in children is very important. Despite having good analgesic effects, the use of opioids is, however, limited due to side effects. Objectives: This study was aimed to investigate the effect of transverse ABDOMINIS plane (TAP) block on the intensity and frequency of pain after appendectomy in children. Methods: In a single-blinded clinical trial, 40 children aged from 4 to 16 years, candidates for the appendectomy, were divided randomly to intervention and control groups. The intervention group received ultrasound-guided TAP block using 0. 25 mL/kg of 0. 25% bupivacaine in the Petit triangle after general anesthesia. Postoperative pain was assessed within the first 24 hours after surgery based on the Wong-Baker FACES Pain Rating Scale (WBFP). Results: There was a reduction in WBFP scores at 2 hours after appendectomy in the intervention group compared with the control group (5. 05 ± 2. 83 vs 6. 30 ± 2. 2063). Also, the pain intensity within 24 hours after surgery in the intervention and control groups was 3. 10 ± 1. 33, and 3. 60 ± 1. 63 respectively according to WBFP scale (P > 0. 05). Conclusions: The TAP block was effective to reduce pain after appendectomy in children, however, there was no significant difference between intervention and control groups. Further studies with larger sample sizes are needed to be done in this area of research.

Background and purpose: TRANSVERSUS abdominal plane block is used in management of pain in patients undergoing abdominal surgery. This study aimed at investigating the effect of ultrasoundguided TRANSVERSUS ABDOMINIS plane block on postoperative pain control in patients undergoing laparoscopic cholecystectomy. Materials and methods: This double-blind randomized clinical trial was performed in 60 patients undergoing laparoscopic cholecystectomy. General anesthesia was induced in all patients. At the end of the operation, a subcostal transverse ABDOMINIS plane (SCTAP) block was performed in the intervention group, while the control group received no intervention. In all samples, pain intensity based on Visual Analogue Scale (VAS) and the dose of opioid and anti-emetics drugs were assessed at recovery, 2, 4, 8, 12, and 24 hours after the surgery. Data analysis was performed in SPSS 24 applying independent t-test and chi-square. Results: The number of patients with VAS<4 was significantly higher in intervention group compared with the control group at recovery (96. 4%), 2 (96. 4%), 4 (89. 2%), and 8 (57. 1%) hours after the surgery (P<0. 05), but, data showed no significant difference between the intervention group and control group at 12 and 24 hours after surgery (P>0. 05). Findings showed significant differences in mean opioid administration during 8 (4. 4 ±,11. 9) and 24 hours (38. 3 ±,21) after surgery between the intervention group and the control group (P<0. 001). The mean use of metoclopramide was not found to be significantly different between the two groups at 8 and 24 hours after surgery (P> 0. 05). Conclusion: Current study showed that ultrasound-guided SCTAP block could reduce postoperative pain and opioid administration after laparoscopic cholecystectomy.

Background: Both TRANSVERSUS ABDOMINIS plane block (TAPB) and quadratus lumborum block (QLB) can provide effective analgesia for abdominal surgery. Objectives: To explore whether there are differences in the effects of TAPB and QLB on the quality of postoperative recovery in patients undergoing laparoscopic radical resection for rectal cancer. Methods: In total, 102 patients undergoing laparoscopic radical resection for rectal cancer were randomly divided into two groups. Bilateral TAPB or QLB was performed using 0. 375% ropivacaine after the induction of anesthesia. The 15-item Quality of Recovery (QoR15) scale was used to assess the quality of recovery at 24 h postoperatively. Secondary indicators included 24-h postoperative fentanyl consumption, patient-controlled analgesia (PCA), incidence of adverse reactions, numerical rating scale (NRS) at rest and during exercise, and incidence of postoperative complications. Results: QoR-15 scores were higher in the QLB group than in the TAPB group (115. 6±, 11. 3 vs. 99. 7±, 14. 2, P<0. 05). Moreover, the 24-h sufentanil consumption was less in the QLB group than in the TAPB group (2. 4±, 0. 5 vs. 5. 5±, 0. 3 μ, g, P<0. 05) after surgery. Time durations to first postoperative PCA compression were 152. 1±, 28. 4 and 100. 3 ±,22. 9 min, respectively (P<0. 05). The numbers of PCA compressions within 24 h after surgery were 6. 0 (2. 0, 8. 0) and 9. 0 (3. 0, 12. 0) (P<0. 05). There were no differences in secondary outcomes, such as adverse reactions, NRS scores at rest and exercise at 24 h postoperatively, as well as complication rates. Conclusion: Patients undergoing laparoscopic radical resection for rectal cancer with QLB had a better quality of recovery and better analgesic effects at 24 h postoperatively, compared to TAPB.

Background: Pain has a wide spectrum of effects on the body and inadequately controlled postoperative pain may have harmful physiologic and psychological consequences and increase morbidity. In addition, opioid anesthetic agents in high doses can blunt endocrine and metabolic responses following surgery and are associated with side effects including dizziness, nausea, vomiting, constipation, and respiratory depression.Objectives: The current study aimed to investigate if unilateral ultrasound-guided transverse abdominal plane block (TAP-block) could reduce pain and postoperative use of patient requested analgesics following nephrectomy compared to local injection of the same ropivacaine dose in the surgical wound.Patients and Methods: Retrospective chart reviews were performed in 42 consecutive patients who received TAP-block in conjunction with nephrectomy from November 2013 to August 2014 (group A). For comparison, data were used from 40 other nephrectomy patients registered as part of a previous study (group B). In this group the patients had received local ropivacaine injection in the surgical wound. On univariate analyses, the groups were compared by t-test and the Fisher exact test. Multivariate analyses were conducted by multiple linear regression.Results: Mean surgical time was 162 minutes in group A and 92 minutes in group B (P<0.0001). The means of visual analogue scale (VAS) were 3.05 and 1.55 in A and B groups, respectively (P=0.001). The means of morphine consumption were 5.2 mg and 5.9 mg in groups A and B, respectively (P=0.58); while the means of sufentanil use were 9.8g and 6.0 g in groups A and B, respectively (P =0.06). When controlling for age, tumor size and American society of anesthesiologists classification (ASA) score on multivariate analysis, TAP-block was associated with a significant increase in VAS (+1.4 [95% CI, 0.6 - 2.3], P=0.001) and sufentanil use (+6.2g [95% CI, 2.3 - 10.2], P=0.003). There was no difference in morphine use on multivariate analysis (P=0.99).Conclusions: TAP-block in conjunction with laparoscopic nephrectomy did not reduce pain or opioid consumption. On the contrary, it seemed to prolong surgical time.