***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVE To compare operative outcomes and postoperative pain of  laparoscopic hysterectomy ( LH ) versus minilaparoscopic hysterectomy ( MLH ) .  DESIGN R and omized controlled trial ( Canadian Task Force Classification I ) . SETTING Tertiary care center . PATIENTS Seventy-six women scheduled to undergo a hysterectomy for a supposed benign gynecologic condition . INTERVENTIONS Participants were r and omly assigned to LH ( n = 38 ) or MLH  ( n = 38 ) . MLH was performed with use of 3-mm ports . Both patients and assessors of the postoperative outcomes were blinded to the size of port used , and patients ' wounds were concealed by st and ard-size nontransparent dressings . MEASUREMENTS Primary outcome was postoperative pain ( both rest and incident on coughing and abdominal pain , as well as shoulder pain ) by use of a 100-mm visual analogue scale . MAIN RESULTS The two groups were similar in terms of operative outcomes . No intraoperative conversion from MLH to both LH and open surgery occurred . No significant difference in pain scores at 1 , 3 , 8 , and 24 hours after surgery between groups was found . Rescue analgesic requirement was similar in the MLH and LH groups ( 21.1 % vs 13.2 % , p = .54 ) . CONCLUSIONS Ports can safely be reduced in size without a negative impact on the surgeon 's ability to perform LH . MLH appears to have no advantage over LH in terms of postoperative pain Objective The aim of this study was to investigate the optimum dosage of dexmedetomidine for prevention of postanesthetic shivering . Methods One-hundred thirty two ASA physical status I-II patients scheduled for elective laparoscopic total hysterectomy were enrolled in this r and omised , placebo-controlled study . Patients were r and omly allocated to receive dexmedetomidine in four groups : group S ( 0.9 % normal saline ) , group D0.5 ( dexmedetomidine 0.5 µg/kg ) , group D0.75 ( dexmedetomidine 0.75 µg/kg ) , group D1.0 ( dexmedetomidine 1.0  µg/kg ) . Time to extubation and tympanic temperature during and after operation were measured . Shivering was grade d ( 0 - 3 scale ) upon patients arrival to the PACU and every ten minutes thereafter up to forty minutes . Sedation and first rescue analgesic time at the PACU were evaluated . Results The incidence of shivering was significantly lower in group D0.75 and D1.0 than in group S ( P < 0.05 ) . There were significantly fewer patients with a shivering score of 2 or 3 in groups D0.75 and D1.0 than in group S ( P < 0.05 , P < 0.001 ) . Extubation time was shorter in group S than in groups D0.75 and D1.0 ( P < 0.05 ) . Tympanic temperature at 40 minutes postoperatively in the recovery room was higher in group S than in the other dexmedetomidine groups ( P < 0.05 ) Fewer patients required rescue analgesia in groups D0.75 and D1.0 than in group S ( P < 0.001 ) , and the time to rescue analgesia was longer in group D1.0 than in group S ( P < 0.001 ) . Modified Observer 's Assessment of Alertness/Sedation ( MOAA/S ) at arrival in the PACU was lower in all dexmedetomidine groups than in group S ( P < 0.05 ) . Conclusions Our results suggest that dexmedetomidine 0.75 or 1.0 µg/kg provides effective prophylaxis against postoperative shivering as well as an analgesic effect . Though potential for intraoperative requirement for atropine , sedation in the immediate recovery period and delayed extubation time with dexmedetomidine was noted , there were no major clinical impacts on the overall recovery from anesthesia BACKGROUND : In this r and omized , controlled , observer-blinded study , we evaluated analgesia provided by transversus abdominis plane ( TAP ) block  after elective total laparoscopic hysterectomy in terms of reduced postoperative morphine consumption as the primary end point . METHODS : Fifty-two patients were r and omly divided into 2 groups : patients in group T ( TAP , n = 26 ) received an ultrasound-guided bilateral TAP block with 40 mL of 0.375 % levobupivacaine and morphine patient-controlled analgesia , whereas patients in group C ( control , n = 26 ) received morphine patient-controlled analgesia . Secondary outcomes included pain measurements ( Numeric Rating Scale from 0 to 10 ) during the first 24 hours postoperatively , times to postanesthesia care unit discharge , times to surgical ward discharge , incidence of postoperative nausea and vomiting , functional capacity measurements in terms of 2-minute walking test , and first oral solid intake . RESULTS : Demographic and anthropometric variables were similar in the 2 groups . The total dose of morphine consumed by patients during postanesthesia care unit stay was 6 ( 0–8 ) mg in group T vs 8 ( 5.5–8.5 ) mg in group C ( P = 0.154 ) . Postoperative morphine consumption during the first 24 hours was 10.55 ± 10.24 mg in group C vs 10.73 ± 13.45 mg in group T ( P = 0.950 ) . The 95 % confidence interval of the difference between means of 24-hour morphine consumption was −7.45 to + 7.09 . The 2 groups were comparable . There were no significant differences in secondary outcome variables between groups . CONCLUSIONS : TAP block did not reduce morphine consumption during the first postoperative 24 hours after elective total laparoscopic hysterectomy STUDY OBJECTIVE To compare the use of low pneumoperitoneum pressure ( LPP ; 8 mm Hg ) vs st and ard pneumoperitoneum pressure ( SPP ; 12 mm Hg ) during  mini-laparoscopic hysterectomy ( MLH ) . DESIGN R and omized controlled trial ( Canadian Task Force classification I ) . SETTING Tertiary care center . PATIENTS Forty-two consecutive women scheduled to undergo MLH to treat benign uterine disease . INTERVENTIONS Women were r and omly selected to undergo MLH using LPP ( n = 20 ) or SPP ( n = 22 ) . MLH was performed via 3-mm ancillary ports . MEASUREMENTS AND MAIN RESULTS The primary outcome was to evaluate changes in abdominal and shoulder-tip pain via a 100-mm visual analog scale at 1 , 3 , and 24 hours postoperatively . All procedures were completed via mini-laparoscopy without the need to increase intra-abdominal pressure or convert to conventional laparoscopy or open surgery . Intraoperatively , 1 episode of severe bradycardia occurred in the LPP group , whereas no intraoperative complications were recorded in the SPP group ( p = .47 ) . No postoperative complications were recorded ( p > .99 ) . Abdominal pain was similar between groups at each time point . Incidence and intensity of shoulder-tip pain at 1 and 3 hours postoperatively was lower in the LPP group than in the SPP group ( p < .05 ) , whereas no between-group differences were observed at 24 hours ( p > .05 ) . Rescue analgesic requirement did not differ statistically between the LPP and SPP groups ( 20 % vs 41 % , respectively ; p = .19 ; odds ratio , 2.7 ; 95 % confidence interval , 0.69 - 11.08 ) . CONCLUSION In experienced h and s , use of LPP is safe and feasible . During performance of MLH , compared with SPP , LPP is a simple method that offers advantages of less shoulder-tip pain OBJECTIVE The objective of the study was to determine whether transversus abdominis plane ( TAP ) block reduces postoperative pain when compared with trocar site infiltration of bupivacaine in gynecological laparoscopy . STUDY DESIGN This was a prospect i ve , r and omized , double-blinded clinical trial using patients as their own controls . Women undergoing gynecologic laparoscopy using a 4-port symmetrical technique were r and omly assigned to right- or left-sided TAP block using 30 mL of 0.25 % bupivacaine with epinephrine . Two cohorts of patients were studied . Cohort 1 consisted of anesthesiologist-administered ultrasound-guided TAP block . Cohort 2 consisted of surgeon-administered laparoscopic-guided TAP block . In both cohorts , contralateral port sites were infiltrated with an equal amount of bupivacaine in divided doses . All patients received intraoperative acetaminophen and ketorolac .  Postoperative abdominal pain was assessed at 1 , 2 , 4 , 6 , 8 , 12 , 18 , 24 , and 48 hours on the block and contralateral sides , before and after palpation , using the 10 point visual analog scale . A 2 point difference in the reported pain scores was considered clinical ly meaningful . RESULTS Eighty-eight patients were eligible for statistical analysis : 45 and 43 patients in cohorts 1 and 2 , respectively . In both cohorts , most patients reported equal pain on the block side and local side . In cohort 1 , there was a statistically significant difference in mean reported pain scores at 2 hours and across time favoring the ultrasound-guided block ; however , this did not reach clinical significance . There was no statistically significant difference found at all other time points or when pain scores were objective ly assessed after palpation of the incisions . When comparing laparoscopic-guided block with local infiltration , there was no statistically significant difference in reported mean pain scores at all time points or after palpation . CONCLUSION As part of this multimodal analgesic regimen , neither block method provided a significant clinical benefit compared with trocar site bupivacaine infiltration BACKGROUND : Apart from being antiemetic , glucocorticoids have an analgesic property . The optimal dose of dexamethasone in the management of pain after surgery has not been established . In this placebo-controlled , dose-finding study , we evaluated the analgesic effect of three doses of dexamethasone  after laparoscopic hysterectomy . METHODS : We r and omized 129 women scheduled for laparoscopic hysterectomy to receive  placebo , dexamethasone 5 mg ( D5 ) , 10 mg ( D10 ) , or 15 mg ( D15 ) IV before the induction of anesthesia . The patients were anesthetized with propofol and remifentanil in a st and ardized manner . Until the first postoperative morning , postoperative pain was managed with IV oxycodone using patient-controlled analgesia . The visual analog scale scores for pain and side effects , and the amounts of the analgesics were recorded for 3 days after surgery . RESULTS : The total dose of oxycodone  ( 0–24 h after surgery ) was smaller in the D15 ( 0.34 mg/kg [ 0.11–0.87 ] ) group than in the placebo group ( 0.55 mg/kg [ 0.19–1.13 ] ) ( P = 0.003 ) . The doses of oxycodone  during Hours 0–2 after surgery were smaller in the D10 ( 0.17 mg/kg [ 0.03–0.36 ] ) and D15 ( 0.17 mg/kg [ 0.03–0.35 ] ) groups than in the placebo ( 0.26 mg/kg [ 0.10–0.48 ] ) ( P = 0.001 , D10 versus placebo ; P < 0.001 , D15 versus placebo ) group . During Hours 2–24 after surgery , however , the doses of oxycodone  were equal in the placebo , D5 , D10 , and D15 groups ( 0.31 mg/kg [ 0.03–0.78 ] , 0.22 mg/kg [ 0.03–0.92 ] , 0.24 mg/kg [ 0.05–0.87 ] , and 0.20 mg/kg [ 0–0.65 ] , respectively ) . The visual analog scale scores for pain at rest , in motion , or at cough did not differ in the study groups . The incidence of dizziness was lower in the D15 group than in the placebo group ( P = 0.001 ) , the D5 group ( P = 0.006 ) , and the D10 group ( P = 0.030 ) during the first 24 h after surgery . During the later course of recovery , the incidence of dizziness did not differ among the four study groups . CONCLUSIONS : IV dexamethasone 15 mg before induction of anesthesia decreases the oxycodone consumption during the first 24 h after laparoscopic hysterectomy . During first 2 h after surgery , dexamethasone 10 mg reduces the oxycodone consumption as effectively as the 15 mg dose PURPOSE The purpose of this study was to compare the effects of ondansetron combined 
    Output:
    
Limited evidence hindered recommendations on alpha-2-agonists .
Inconsistent evidence was found in the studies investigating pregabalin and transversus abdominis plane block , and no evidence was found for intraperitoneal local anesthetics , port site infiltration , or single-port laparoscopy .
Measures to lower peritoneal insufflation pressure or humidify or heat insufflated gas seem to reduce the incidence of shoulder pain , but not abdominal pain .