***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: MATERIAL S AND METHODS 83 adult patients included in the study were divided into two groups . Patients of the group-1 ( n-49 ) had medium level of pain after cancer head and neck surgery . Patients of the group-2 ( n-34 ) had severe pain . Three first postoperative days their post-operative multimodal analgesia started with tenoxycam 20 mg i.m . after induction of anesthesia , then every 24 hour ( 58 patients ) . 25 patients got ketoprofen 100 mg i.m . every 8 - 12 hours instead of tenoxycam . All patients had nefopam 30 mg i.m . 30 min prior the end of surgery procedure , and every 8 hours afterwards . 7 patients of the group-1 had more than 4 pain scores ( day 1 ) , 4 patients --at the day 2 . They received tramadol or paracetamol additionally . 7 patients ( group-2 ) also had up to 5 pain scores on the day 1 , 5 patients had 4 pain scores on the day 2 , and 3 patients 4 pain scores on the day 3 . All that patients received additional analgesia with tramadol or trimeperidine once a day . 8.4 % of patients suffered from adverse reactions ( tachycardia , PONV and sweating ) . CONCLUSION This method of multimodal postoperative analgesia is very simple and fairly efficient Objective . To assess whether early or immediate removal of a  12F in‐dwelling Foley catheter after total abdominal hysterectomy affects the level of subjective pain assessment postoperatively . Design . R and omized controlled trial . Setting . University Hospital . Population . Seventy women underwent total abdominal hysterectomies for various benign gynecological diseases . Methods . Women were r and omized to have the urinary catheter removed in the operating room after the surgical procedure or to have it removed on postoperative day 1 . Main outcome measures . The primary outcome was patients ’ pain assessment and the secondary outcomes were rate of re‐catheterization and symptomatic urinary tract infection . Results . There was no difference in the pain assessment between the two groups . A significantly higher number of urinary retention episodes requiring re‐catheterization were found in the immediate removal group compared with the delayed removal group ( 20 vs. 0 % ; p= 0.011 ) . The incidence of symptomatic urinary tract infection did not differ between the two groups . Conclusions . There are pros and cons regarding the policy of one‐day in‐dwelling catheterization compared to immediate catheter removal BACKGROUND Mild perioperative hypothermia , which is common during major surgery , may promote surgical-wound infection by triggering thermoregulatory vasoconstriction , which decreases subcutaneous oxygen tension . Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen . Hypothermia also directly impairs immune function . We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization . METHODS Two hundred patients undergoing colorectal surgery were r and omly assigned to routine intraoperative thermal care ( the hypothermia group ) or additional warming ( the normothermia group ) . The patient 's anesthetic care was st and ardized , and they were all given cefam and ole and metronidazole . In a double-blind protocol , their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks ; wounds containing culture-positive pus were considered infected . The patients ' surgeons remained unaware of the patients ' group assignments . RESULTS The mean ( + /- SD ) final intraoperative core temperature was 34.7 + /- 0.6 degrees C in the hypothermia group and 36.6 + /- 0.5 degrees C in the normothermia group ( P < 0.001 ) Surgical-wound infections were found in 18 of 96 patients assigned to hypothermia ( 19 percent ) but in only 6 of 104 patients assigned to normothermia ( 6 percent , P = 0.009 ) . The sutures were removed one day later in the patients assigned to hypothermia than in those assigned to normothermia ( P = 0.002 ) , and the duration of hospitalization was prolonged by 2.6 days ( approximately 20 percent ) in hypothermia group ( P = 0.01 ) . CONCLUSIONS Hypothermia itself may delay healing and predispose patients to wound infections . Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations OBJECTIVE To examine the effects of an educational intervention , in the form of printed material , on  patient knowledge and recall of possible risks from  parotidectomy or thyroidectomy .  DESIGN Prospect i ve , r and omized , controlled study conducted during a 9-month period . SETTING Head and neck surgery clinic of an academic tertiary care hospital . PATIENTS One hundred twenty-five consecutive patients older than 16 years who were undergoing thyroidectomy or parotidectomy at the head and neck surgery clinic were recruited . Four patients were excluded from analysis because their follow-up interview was not within the required limits . INTERVENTION At the preoperative visit during the routine consent process , both groups received a verbally delivered checklist of risks specific for the surgery to be performed . The intervention group was also given a pamphlet with written information accompanied by illustrations . MAIN OUTCOME MEASURES The effectiveness of the educational intervention  was determined by comparing the average rate of risk recall between the intervention and control groups . The effects of age , sex , level of education , and time between the consent and recall interviews on recall rate were also assessed . RESULTS The overall risk recall rate for both procedures was 39.1 % . The recall rate of the intervention group was 50.3 % compared with 29.5 % for the control group ( P<.001 ) . CONCLUSIONS The intervention consistently improved risk recall for all patients regardless of age , sex , and level of education . Patients ' ability to recall potential risks was significantly increased by an educational intervention ; all patients would benefit from this intervention Closed-suction drainage was compared prospect ively to open , passive drainage ( Penrose drains ) in 128 patients undergoing cholecystectomy . Patients were r and omized at the time of operation to receive either closed-suction drains ( Group I , 67 patients ) or Penrose drains ( Group II , 61 patients ) . The preoperative clinical parameters of the two groups were similar . The patients in Group I when compared with those in Group II had a shorter duration of drainage ( 3.3 days and 4.1 days , respectively , p less than 0.01 ) , a lesser volume of drainage in the first 48 hours postoperatively ( 78 ml and 132 ml , respectively , p less than 0.001 ) , a decreased incidence of fever on the night of operation ( 24 of 67 patients and 39 of 61 patients , respectively , p less than 0.05 ) and on the first postoperative day ( 26 of 67 patients and 32 of 61 patients , respectively , p less than 0.05 ) , and a lower leukocyte count on the first postoperative day ( 12,000 cells/mm3 and 14,100 cells/mm3 , respectively , 0.05 less than p less than 0.1 ) . Patients in Group I tended to have a lower rate of wound infection ( 1 of 67 patients versus 5 of 61 patients in Group II , 0.05 less than p less than 0.1 ) and had a much lower incidence of drain site tenderness ( 8 of 67 patients in Group I versus 24 of 61 patients in Group II , p less than 0.05 ) . This study demonstrates the superiority of closed-suction drains over open , passive drains after cholecystectomy OBJECTIVE To assess the effects of 2 different anesthetic techniques on early complications after superior pharyngeal flap surgery . DESIGN R and omized , prospect i ve , single-blind study . SETTING Large referral hospital . PATIENTS One hundred patients undergoing superior pharyngeal flap surgery for the correction of velopharyngeal insufficiency were r and omly divided into 2 equal groups to receive either isoflurane or propofol-based anesthesia . INTERVENTIONS Following induction of anesthesia with fentanyl citrate and propofol , patients were r and omized to receive either isoflurane or propofol for the maintenance of general anesthesia . The inspired isoflurane concentration and propofol infusion rate were adjusted to maintain a stable depth of anesthesia as judged by clinical signs and hemodynamic responses to surgical stimuli . MAIN OUTCOME MEASURES Recovery from anesthesia , recovery from surgery , and early postoperative complications . RESULTS The groups were similar in age , weight , height , induction time , surgery time , extubation time , and anesthetic time . The time ( mean + /- SD ) required to achieve a maximal Steward Recovery Score was 7 + /- 14 minutes in the propofol group compared with 32 + /- 28 minutes in the isoflurane group ( P<.04 ) . No significant differences in postoperative patient satisfaction scores , time to first swallow , drinking time , and time to " home readiness " were noted . Overall , 17 patients ( 17 % ) developed airway-related complications and 2 of the patients ( 2 % ) were accounted as severe . Two patients ( 2 % ) bled from the operation site . However , there was no difference in the incidence of postoperative complications between the groups . CONCLUSIONS When compared with isoflurane administration for maintenance of general anesthesia , propofol-based anesthesia was associated with more rapid mental and psychomotor recovery . However , airway-related complications and " home readiness " were similar between the groups Study Design A preintervention and postintervention design was used to examine a total of 200 patients . Objective After successful implementation at our institution of a perioperative oral multimodal analgesia protocol in major joint arthroplasty , a modified regimen was provided to patients undergoing spine procedures . Summary of Background Data A proactive , multimodal approach is currently recommended for the management of acute postoperative pain . Inadequate postoperative analgesia can negatively influence surgical outcome and duration of rehabilitation . Routine use of intravenous patient controlled analgesia ( IV PCA ) after surgery can result in substantial functional interference , side effects , and lead to untoward events as a result of programming errors . Methods A preintervention and postintervention design was used to compare a  historical control group of spine surgery patients who received conventional IV PCA ( N=100 ) with a prospect i ve group  who received some form of perioperative oral multiodal analgesis ( N=100 ) . The new regimen included preoperative and postoperative scheduled extended-release oxycodone , gabapentin , and acetaminophen , intraoperative dolasetron and as-needed postoperative short-acting oral oxycodone . Patient surveys and chart audits were used to measure pain intensity , functional interference from pain , opioid consumption , analgesic-related side effects , and patient satisfaction over the first 24 hours postoperatively . Results Patients who received the new perioperative multimodal oral regimen had significantly less opioid consumption ( P<0.001 ) , lower ratings of Least Pain ( P<0.01 ) , and experienced less nausea ( P<.001 ) , drowsiness ( P<0.05 ) , interference with walking ( P=0.05 ) , and coughing and deep breathing ( P<0.05 ) compared with the IV PCA group . Conclusions This quality improvement study shows some safety and significant advantages of a multimodal perioperative oral analgesic regimen compared with st and ard IV PCA after spine surgery Background : The almost single disadvantage of conventional polyurethane film dressings , uncontrolled leakage , is probably as often described as its numerous advantages for split-thickness skin graft donor sites . This shortcoming can be overcome by perforating the polyurethane dressing , which permits controlled leakage into a secondary absorbent dressing . The study was conducted to compare the polyurethane dressing system and Aquacel , a hydrofiber wound dressing , which also seems to fulfill all criteria of an ideal donor-site dressing . Methods : This prospect i ve , r and omized , double-blind clinical trial included 50 adult patients . Skin graft donor sites were divided equally for the application of Aquacel and polyurethane dressing . The dressings were kept unchanged for 10 days . After removal of the dressing at day 10 , the epithelialization rate of both sites was evaluated . Pain scores were assessed according to a 0 to 5 numeric pain scale every postoperative day and during dressing removal . Results : On postoperative day 10 , 86.4 percent of the polyurethane dressing donor sites showed complete reepithelialization compared with 54.5 percent of the Aquacel-treated donor sites ( p < 0.001 ) . Polyurethane dressing was significantly less painful until and during removal of the dressing ( p < 0.001 ) . There was no significant difference with respect to scar formation . Conclusions : Overall , polyurethane dressing was superior to Aquacel . Further attributes of the polyurethane dressing such as ease of application , low labor input , high patient comfort , and protection against secondary wound infection qualify this dressing system as an ideal wound covering for donor sites . CLINICAL QUESTION /LEVEL OF EVIDEN 
    Output:
    
Best practice includes several elements of perioperative care .