***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: BACKGROUND In an era of cost containment and outcome -based medicine , bariatric surgeons are attempting to decrease perioperative morbidity and streamline care . One way of accomplishing this is by decreasing opioid use and hospital stay . Several studies of nonbariatric open procedures have shown that continuous infusion catheters ( CIC ) are beneficial . Bariatric surgeons frequently utilize CIC , but the data is sparse for the clinical efficacy in laparoscopic procedures . OBJECTIVE Evaluate the efficacy of CIC in laparoscopic sleeve gastrectomy . SETTING military teaching hospital . METHODS In this single institution prospect i ve r and omized double-blind controlled study , 82 patients undergoing laparoscopic sleeve gastrectomy ( LSG ) received either .2 % ropivacaine or .9 % normal saline ( placebo ) via CIC . After discharge , total narcotic usage , total antiemetic usage , pain scores , and hospital length of stay were evaluated . A one-way ANOVA was used to assess statistical significance . Power was 80 % to detect 52 mg morphine equivalent difference . RESULTS A total of 82 patients were enrolled , 39 received ropivacaine , and 43 received placebo . There was no statistically significant difference in narcotic usage between the ropivacaine group and placebo group , 51.9 mg versus 55.2 mg , respectively ( P = .63 ) . Ondansetron usage was 10.7 mg and 10.6 mg for ropivacaine and placebo groups . ( P = .98 ) . Average pain score was 3.0 for each group ( P = .632 ) . Total hospital length of stay was 37.5 hours for ropivacaine group and 38.1 hours for placebo group ( P = .768 ) . CONCLUSIONS We found no difference in narcotic usage , antiemetic usage , pain scores , or hospital length of stay between ropivacaine and placebo groups . We conclude there is no utility of CIC in LSG BACKGROUND Postoperative pain can be prevented . Gabapentin may be effective in this role . Our primary objective was to test the hypothesis that a prophylactic administration of gabapentin in obese patients before surgery has an opioid-sparing effect and reduces postoperative oxycodone consumption more efficiently than placebo . METHODS The study enrolled 113 patients undergoing laparoscopic sleeve-gastrectomy under general anesthesia . The patients were r and omly allocated to the control or gabapentin group and received a single oral dose of gabapentin 1200 mg or a matching placebo 1 h before surgery . RESULTS The mean time from the end of anesthesia to the commencement of analgesic therapy was 74.3±37.8 minutes in the placebo group and 110.4±65.4 minutes with gabapentin ( mean difference : -36 , 95 % CI : 12 to 40 , P=0.0004 ) . The mean 12-hour oxycodone consumption was 31.5±10 mg with placebo and 26.3±10 mg with gabapentin ( mean difference : -5.2 mg , 95 % CI : -9.08 to -1.35 , P=0.0085 ) . The mean NRS pain intensity at 12 hours was 2±0.9 in the placebo group and 1.5±0.9 with gabapentin ( mean difference : -0.5 , 95 % CI : 0.15 to 0.81 , P=0.003 ) . CONCLUSIONS The dem and for oxycodone was delayed in the gabapentin group ; also , the total 12-hour dose requirement of oxycodone was lower in the gabapentin group Purpose The transversus abdominis plane ( TAP ) block is a technique increasingly used for analgesia after surgery on the anterior abdominal wall . We undertook this study to determine the feasibility and analgesic efficacy of ultrasound-guided TAP blocks in morbidly obese patients . We describe the dermatomal spread of local anesthetic in TAP blocks administered , and test the hypothesis that TAP blocks decrease visual analog scale ( VAS ) scores . Patients and methods After ethics committee approval and informed consent , 35 patients with body mass index > 35 undergoing single-port sleeve gastrectomy ( SPSG ) were enrolled . All patients received balanced general anesthesia , followed by intravenous patient-controlled analgesia ( IV-PCA ; hydromorphone ) postoperatively ; all reported VAS > 3 upon arrival to the recovery room . From the cohort of 35 patients having single-port laparoscopy ( SPL ) , a sealed envelope method was used to r and omly select ten patients to the TAP group and 25 patients to the control group . The ten patients in the TAP group received ultrasound-guided TAP blocks with 30 mL of 0.2 % Ropivacaine injected bilaterally . The dermatomal distribution of the sensory block ( by pinprick test ) was recorded . VAS scores for the first 24 hours after surgery and opioid use were compared between the IV-PCA+TAP block and IV-PCA only groups . Results Sensory block ranged from T5–L1 . Mean VAS pain scores decreased from 8 ± 2 to 4 ± 3 ( P=0.04 ) within 30 minutes of TAP block administration . Compared with patients given IV-PCA only , significantly fewer patients who received TAP block had moderate or severe pain ( VAS 4–10 ) after block administration at 6 hours and 12 hours post-surgery . However , cumulative consumption of hydromorphone at 24 hours after SPSG surgery was similar for both groups . Conclusion Ultrasound-guided TAP blocks in morbidly obese patients are feasible and result in satisfactory analgesia following SPSG in the immediate postoperative period BACKGROUND OFIRMEV is an intravenous form of acetaminophen approved by the Food and Drug Administration for use as an antipyretic and treatment of mild to moderate pain alone or in conjunction with opioid medications . Intravenous APAP use in postsurgical pain management has been reported to decrease opioid usage , time to rescue dose , and subjective pain . OBJECTIVES We used a placebo-controlled , r and omized double-blind study to test the efficacy of OFIRMEV in decreasing opioid use and subjective pain after laparoscopic sleeve gastrectomy . SETTING U.S. military training hospital . METHODS Thirty-four patients who met criteria were enrolled and r and omly assigned to 2 separate limbs of the study . The OFIRMEV  and placebo groups had similar mean age ranges ( 48±11 and 50±11 yr ) and a female/male ratio of 5:1 and 6:1 , respectively . The patients received an intraoperative dose and then postoperative administration of intravenous OFIRMEV 1 g or placebo every 6 hours for 24 hours in addition to fentanyl via patient-controlled analgesia . Subjective pain scores , the total amount of fentanyl used , time to rescue of first narcotic dose , and total postanesthesia care unit ( PACU ) narcotic use were measured during the first 24 hours after surgery . RESULTS Subjective pain score was significantly decreased compared with baseline at 12 , 16 , and 20 hours after surgery in OFIRMEV-treated patients but not in the placebo group . However , total narcotic use , time to rescue of first narcotic dose , and total PACU narcotic dose were not statistically different between the 2 groups . CONCLUSION Intravenous OFIRMEV use caused a modest but statistically significant decrease in subjective pain without affecting narcotic use after laparoscopic sleeve gastrectomy . ( Surg Obes Relat Dis 2015;0:000 - 00 . ) © 2015 American Society for Metabolic and Bariatric Surgery . All rights reserved BACKGROUND AND OBJECTIVE Postoperative nausea and vomiting ( PONV ) occur frequently after laparoscopic bariatric surgery . The combination of haloperidol , dexamethasone , and ondansetron may reduce these undesirable events . The aim of this study was to evaluate the intensity of nausea and pain , the number of vomiting episodes , and morphine consumption in postoperative ( PO ) obese patients undergoing laparoscopic sleeve gastrectomy ( LSG ) . METHOD A clinical , r and omized , controlled , double-blind study conducted with 90 patients with body mass index ≥ 35 kg.cm(-2 ) . Patients were divided into three groups of 30 individuals to receive ondansetron 8 mg ( Group O ) ; ondansetron 8 mg and dexamethasone 8 mg ( Group OD ) ; and ondansetron 8 mg , dexamethasone 8 mg , and haloperidol 2 mg ( Group HDO ) . We evaluated the intensity of nausea and pain using the verbal numeric scale , cumulative number of vomiting episodes , and morphine consumption in the period of 0 - 2 , 2 - 12 , 12 - 24 , and 24 - 36 hours postoperatively . RESULTS Nausea intensity was lower in Group HDO compared to Group O ( p = 0.001 ) , pain intensity was lower in Group HDO compared to Group O ( p = 0.046 ) , and morphine consumption was lower in Group HDO compared to Group O ( p = 0.037 ) . There was no difference between groups regarding the number of vomiting episodes ( p = 0.052 ) . CONCLUSION The combination of haloperidol , ondansetron , and dexamethasone reduced nausea and pain intensity and morphine consumption in postoperative obese patients undergoing LSG Background : The use of opioids in surgeries for morbidly obese patients could cause respiratory depression . Therefore , alternative analgesics are needed to improve anesthetic management for obese patients . The objective of this study was to compare the effect of dexmedetomidine and clonidine on pain as well as analgesic consumption at 24 h postoperatively in patients undergoing laparoscopic gastric sleeve . The secondary objective was to compare patients ’ and surgeons ’ satisfaction . Material s and Methods : A total of 60 obese and morbidly obese patients scheduled to undergo laparoscopic gastric sleeve were r and omly assigned into two groups . 10 min after induction of general anesthesia , one group received 0.8 - 1.2 μg/kg/30 min intravenous ( IV ) clonidine through 500 mL lactated Ringer 's solution and placebo ( normal saline solution ) through syringe pump . The second group received IV dexmedetomidine through syringe pump at a rate 0.5 - 0.8 μg/kg/h and placebo through 500 mL lactated Ringer 's solution . Data on pain , analgesic consumption , and return to normal activity in addition to patients ’ and surgeons ’ satisfaction were collected . Results : Both groups were similar with respect to demographic and intraoperative hemodynamic characteristics . Fentanyl consumption , surgery duration and hospital stay were similar for the two groups . Pain scores on walking were significantly lower in the clonidine group at 12 h postoperatively ( P = 0.014 ) compared with dexmedetomidine group . The number of patients who consumed pethidine was significantly lower in the clonidine group at 12 h postoperatively ( P = 0.045 ) . Conclusion : This study concluded that clonidine and dexmedetomidine yielded similar outcomes with a difference in pain and analgesic consumption at 12 h postoperatively Introduction Although bariatric surgery is actually mainly performed laparoscopically , analgesic optimization continues being essential to reduce complications and to improve the patients ’ comfort . The aim of this study is to evaluate the postoperative pain after analgesia iv exclusively , or associated with epidural analgesia or port-sites infiltration with bupivacaine . Patients and methods A prospect i ve r and omized study of patients undergoing laparoscopic sleeve gastrectomy between 2012 and 2014 was performed . Patients were divided into three groups : Analgesia iv exclusively ( Group 1 ) , epidural analgesia + analgesia iv ( Group 2 ) and port-sites infiltration + analgesia iv ( Group 3 ) . Pain was quantified by means of a Visual Analogic Scale , and morphine rescue needs were determined 24 h after surgery . Results A total of 147 were included . Groups were comparable in age , gender and BMI . There were no differences in operation time , complications , mortality or hospital stay between groups . Median pain 24 h after surgery was 5 in Group 1 , 2.5 in Group 2 and 2 in Group 3 ( P = 0.01 ) , without statistically significant differences between Groups 2 and 3 . In Group 1 , morphine rescue was necessary in 16.3 % of the cases , 2 % in Group 2 and 2 % in Group 3 ( P = 0.014 ) , without statistically significant differences between Groups 2 and 3 . Conclusion Epidural analgesia and port-sites infiltration with bupivacaine , associated with analgesia iv , reduce the postoperative pain , when compared with analgesia iv exclusively . Clinical trials Clinical Trials.gov Identifier : NCT02662660 Background The treatment of pain in obese patients is always a challenge . These patients have low pain thresholds , and the use of opioids can be especially harmful . Intraoperative nervous fiber section and the high temper 
    Output:
    
Gabapentinoids and transversus abdominis plane blocks reduced LSG postoperative pain .
There was limited procedure-specific evidence of analgesic effects for acetaminophen , non-steroidal anti-inflammatory drugs , dexamethasone , magnesium , and tramadol in this setting .
Inconsistent evidence was found in the studies investigating alpha-2-agonists .
No evidence was found for intraperitoneal local anesthetic administration or single-port laparoscopy .