***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 
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    ***EXAMPLES*** 
    Input: Background and objective Local anaesthetics administered intraabdominally have been found to reduce analgesic requirements postoperatively after hysterectomy . This study was design ed to assess the optimal dose of local anaesthetics for best pain relief . Methods Sixty patients undergoing abdominal hysterectomy were r and omly divided into three groups to receive 10 ml h−1 infusion of levobupivacaine intraabdominally postoperatively for 48 h in a double-blind manner : group L , 7.5 mg h−1 ; group M , 12.5 mg h−1 and group H , 17.5 mg h−1 . Pain intensity was measured using the numeric rating scale , ketobemidone consumption over 48 h was measured with a patient-controlled analgesia pump , recovery parameters , expiratory muscle strength , time to home readiness , plasma concentration of levobupivacaine and health-related quality of life were all measured at defined time points postoperatively . Results No differences were found between the active groups in pain intensity , recovery parameters or health-related quality of life . Pain intensity was maximal during 0–4 h and during coughing . Expiratory muscle strength decreased significantly during 0–4 h in all active groups , with no differences between the groups . Plasma concentration of levobupivacaine was below known toxic concentrations in humans , and no patient had symptoms of local anaesthetic toxicity . Health-related quality of life showed improved scores at 3 months after the operation compared with preoperative values , but no differences between the groups were found in any of the parameters . Conclusion Satisfactory analgesia can be achieved with low doses of levobupivacaine administered intraabdominally , except during the early postoperative period . No advantages were seen in this study when higher doses of levobupivacaine were administered as a continuous infusion for postoperative pain relief We have compared pain scores at rest and on st and ardized movement , and morphine consumption using patient-controlled analgesia in 60 patients who had undergone total abdominal hysterectomy . Patients were allocated r and omly to one of three groups : in the saline group , 0.9 % sodium chloride 50 ml was administered into the pelvic cavity before closure of the peritoneum ; in the second group , the solution administered was 20 ml of 0.5 % bupivacaine solution with epinephrine 1:200,000 diluted with saline to a final volume of 50 ml ; in the third group , the solution used was 20 ml [ corrected ] of 2 % lidocaine with epinephrine 1:200,000 diluted with saline to a final volume of 50 ml . We found that there was no significant difference between the three groups in visual analogue pain scores at 8 , 12 , 36 or 48 h after operation at rest or on movement , and no significant difference in sedation or dose of antiemetic administered . Mean morphine consumption in the first 24 h was 54.6 ( SEM 5.9 ) mg in the saline group , 55.5 ( 6.4 ) mg in the bupivacaine group and 52.5 ( 5.3 ) mg in the lidocaine group . In the second 24 h , morphine consumption was 34.9 ( 6.6 ) mg , 28.1 ( 3.5 ) mg and 28.0 ( 3.5 ) mg in the three groups , respectively . We conclude that i.p . administration of local anaesthetic solution into the pelvic cavity did not confer appreciable analgesia in patients undergoing abdominal hysterectomy The effects of continuous intravenous infusion of lidocaine on  postoperative paralytic ileus in cholecystectomized patients was investigated in this double-blind study . An infusion of lidocaine ( 3 mg/min , n = 15 ) or an infusion of an equal volume of saline ( n = 15 ) was started 30 min before induction of anesthesia and continued for 24 h after surgery . Postoperative colonic motility was evaluated by radiopaque markers and serial abdominal radiographs . A record was kept of the first passage of gas and feces . Results showed significantly earlier return of propulsive motility in the colon of lidocaine-treated patients . Radiopaque markers in the lidocaine group were propelled significantly earlier from the cecum/ascending colon to the transverse colon ( P < 0.05 ) and appeared significantly earlier in the descending colon ( P < 0.05 ) and the rectosigmoid colon ( P < 0.05 ) than in saline-treated patients . Despite the fact that the mean time for postoperative defecation occurred 17 h earlier in lidocaine-treated patients , differences between the groups were not statistically significant — a fact due , perhaps , to great individual variations in defecation habits . The time to first passage of gas , a variable representative of changes in anorectal or colonic tone rather than propagative motility , also did not differ significantly between the groups . No adverse reactions to lidocaine were reported . The results suggest that continuous intravenous infusion of lidocaine during the first postoperative day shortens the duration of paralytic ileus in the colon after abdominal surgery . Supression of inhibitory gastrointestinal reflexes by reduction of postoperative peritoneal irritation is suggested as the mechanism of action This prospect i ve , double-blind , r and omized , and placebo-controlled study evaluates the effectiveness of intraperitoneal bupivacaine in decreasing the length of stay for elective laparoscopic cholecystectomy patients . Seventy-seven patients undergoing elective laparoscopic cholecystectomy before noon at a single institution and by a single group of surgeons were entered into the study . The pharmacy r and omly assigned each patient to one of four study groups ( control , predissection , postdissection , and both ) . Two syringes ( A and B ) containing 15 cm3 of either normal saline or 0.5 per cent bupivacaine were sent with the patient to surgery . Syringe A was sprayed over the perihepatic area before any dissection , and B was sprayed over the perihepatic area just before port removal . Preoperative , intraoperative , and postoperative data were collected . Sixty-six patients completed the study : control , 14 ; predissection , 18 ; postdissection , 15 ; and both , 19 . There was no statistical difference between the predissection , postdissection , and both groups regarding same-day discharge . Therefore , these groups were combined for comparison against the control group . The study found that patients receiving bupivacaine at any time during the surgery were more likely to go home the same day as their procedure ( 79 % vs 43 % , respectively : P < 0.02 ) In this preliminary r and omized study , we have measured pain scores at rest and on movement , 24 and 48 h after operation in 19 control patients , who received 50 ml of saline i.p . , and in 20 test patients , in whom 50 ml of saline solution containing lignocaine 200 mg and adrenaline 1:500,000 were instilled into the peritoneal cavity after total abdominal hysterectomy .  We found that there was no difference in linear analogue scores for nausea , pain on movement or morphine consumption after operation between the two groups , but pain scores at rest were significantly lower in the lignocaine group at 24 and 48 h compared with the saline group . In the lignocaine group , blood sampling over a 3-h period revealed a mean maximum serum concentration of 0.4 microgram ml-1 at 3 h and a highest concentration in any patient of 0.87 microgram ml-1 Background A st and ard approach for postoperative analgesia in laparoscopic surgery is to infiltrate the incisions with local anesthetic in combination with systemic opioids . The intraperitoneal introduction of local anesthetic in this setting has the potential to provide appropriate analgesia without the side effects of systemic opioids . We performed a r and omized clinical trial of the On-Q pump delivery system to determine the safety and efficacy of this device for this novel purpose . Methods Thirty patients undergoing laparoscopic adjustable gastric b and ing were r and omly assigned to one of two groups . The treatment group received On-Q pump systems filled with 0.375 % bupivacaine , while the control group received pumps filled with 0.9 % normal saline . The pump ’s catheter was introduced intraperitoneally , and bupivacaine or saline was then delivered for the first 48 h after surgery . Patient ’s subjective pain scores were evaluated at preset intervals . In addition , shoulder pain , morphine requirements , and anti-emetic requirements were tabulated . Results A statistically significant decrease in patient ’s subjective reports of pain by visual analog score was noted in the On-Q group 1.8 ± 1.93 vs. control 3.5 ± 2.4 , p < 0.046 and remained significant until the end of the study ( 48 h ) . No statistical difference was noted in shoulder pain , morphine requirements , or anti-emetic requirements at any time point . Conclusion Our trial was able to provide evidence of significant reduction in postoperative pain as measured by subjective pain scores with the use of continuous intraperitoneal bupivacaine using the On-Q pain pump system . Further investigation is warranted to evaluate the cost effectiveness of this technique Abdominal hysterectomy is associated with moderate to severe postoperative pain . We r and omly divided 40 patients ( ASA status I – II ) undergoing elective abdominal hysterectomy into 2 groups : group P received an infusion of normal saline 5 mL/h via a catheter placed intraperitoneally at the end of surgery , and group L received 0.25 % levobupivacaine 12.5 mg/h ( 5 mL/h ) . Ketobemidone was administered IV via a patient-controlled analgesia pump as a rescue analgesic in all patients . The catheter was removed after 24 h. Incisional pain , deep pain , and pain on coughing were assessed 1 , 2 , 3 , 4 , 8 , 16 , and 24 h after surgery by using a visual analog scale . Ketobemidone consumption during 0–72 h was recorded . Time to sit , walk , eat , and drink ; home discharge ; and plasma concentrations of levobupivacaine were also determined . Pain at the incision site , deep pain , and pain on coughing were all significantly less in group L compared with group P at 1–2 h after surgery . After 4 h , the mean visual analog scale pain scores at rest and during coughing remained <3 cm during most time periods . Total ketobemidone consumption during 4–24 h was significantly less in group L compared with group P ( mean , 19 versus 31 mg , respectively ) . A less frequent incidence of postoperative nausea , but not vomiting , was also found during 4–24 h in group L compared with group P ( P < 0.025 ) . Total and free plasma concentrations of levobupivacaine were small . We conclude that levobupivacaine used as an infusion intraperitoneally after elective abdominal hysterectomy has significant opioid-sparing effects In a double-blind prospect i ve study , 20 patients undergoing major abdominal surgery were allocated r and omly to receive a continuous 8-h i.p . infusion of either physiological saline or 0.25 % bupivacaine 20 ml h-1 ( in saline ) following a loading dose of saline 1 ml kg-1 or 0.25 % bupivacaine 1 ml kg-1 on entering the peritoneum . The following variables were measured before and at 2-h intervals during the infusion : serum glucose and cortisol concentrations , forced vital capacity , forced expiratory volume in the first second , peak expiratory flow rate and pain at rest , on mobilization and on coughing ( visual analogue scale ) . Postoperative pain , impairment in pulmonary function and increase in serum cortisol and glucose concentrations were not influenced by the i.p . infusion of bupivacaine when compared with saline . This study shows that the i.p . instillation of therapeutically safe doses of bupivacaine was without effect in the management of pain , postoperative pulmonary dysfunction and the stress response in this group of patients Background Peritoneal involvement is a significant issue in the treatment of gastrointestinal malignancies . Current statistics indicate that after surgical intervention , up to 20 % of patients will present with locoregional metastasis . The ability to inhibit initial tumor adhesion to the mesothelial lining of the peritoneum may be considered critical in the inhibition of tumor development . This article describes , the use of a novel nebulizer system capable of delivering high-concentration , low-dose therapeutics to the peritoneal cavity . Methods For this study , 30 male WAG rats were inoculated with CC531 colorectal tumor cells . The rats were r and omized into three groups : control group ( n = 10 ) , heparin-treated group ( n = 10 ) , and high-molecular-weight hyaluronan-treated group ( n = 10 ) . A peritoneal cancer index was used to determine tumor burden at 15 days . Analysis of variance ( ANOVA ) was used to compare multiple group means . Results Nebulization therapy was performed without any complication in the cohort . Heparin inhibited macroscopic intraperitoneal tumor growth completely ( p = 0.0001 ) without affecting tumor cell viability . The introduction of hyaluronan attenuated both tumor size and distribution , was compared with the control group 
    Output:
    
Post-operative pain was reduced but not opioid use .
There was blunting of postoperative hyperglycaemia .
There was no difference in post-operative cortisol response .
Return of bowel function appeared to be quickened , although meta- analysis was not possible .
The use of IPLA is safe and appears to have clinical benefits .