***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 : Transversus abdominis plane block is a safe , simple and effective technique of providing analgesia for lower abdominal surgeries with easily identifiable l and marks . Aims : To compare the analgesic efficacy of transversus abdominis plane block with that of direct infiltration of local anesthetic into surgical incision in lower abdominal procedures . Setting s and Design : Prospect i ve r and omized controlled trial in lower abdominal surgeries done under general anesthesia . Material s and Methods : 52 ASA I-II patients undergoing lower abdominal gynecological procedures under general anesthesia were divided r and omly into two groups each after written informed consent . A bilateral TAP block was performed on Group T with 0.25 % bupivacaine 0.6 ml/kg with half the volume on either side intra-operatively after skin closure before extubation using a short bevelled needle , whereas Group I received local infiltration intra-operatively after skin closure with the same amount of drug . The time taken for the first rescue analgesic and visual analog score ( VAS ) was noted , following which , the patient was administered intravenous morphine 0.1 mg/kg and connected to an intravenous patient controlled analgesia system with morphine for 24 hrs from the time of block administration . 24 h morphine requirement was noted . VAS and sedation scores were noted at 2 , 4 , 6 and 24 h postoperatively . Statistical Analysis Used : The results were analyzed with SPSS 16 . A P value < 0.05 was considered significant . Duration of analgesia and 24 h morphine requirement was analysed by Student 's t-test . VAS scores , with paired comparisons at each time interval , were performed using the t-test or Mann-Whitney U-test , as appropriate . Categorical data were analyzed using Chi square or Fisher 's exact test . Results : In Group T , the time to rescue analgesic was significantly more and the VAS scores were lower ( P = 0.001 and 0.003 respectively ) . The 24 hr morphine requirement and VAS at 2 , 4 , 6 and 24 h were less in the Group T ( P = 0.001 ) . Incidence of PONV was significant in Group I ( P = 0.043 ) , whereas Group T were less se date d at 2 and 4 h ( P = 0.001 and 0.014 ) . Conclusions : Transversus abdominis plane block proved to be an effective means of analgesia for lower abdominal surgeries with minimal side-effects A system has been constructed to evaluate the design , implementation , and analysis of  r and omized control trials ( RCT ) . The degree of quadruple blinding ( the r and omization process , the physicians and patients as to therapy , and the physicians as to ongoing results ) is considered to be the most important aspect of any trial . The analytic techniques are scored with the same emphasis as is placed on the control of bias in the planning and implementation of the studies . Description of the patient and treatment material s and the measurement of various controls of quality have less weight . An index of quality of a RCT is proposed with its pros and cons . If published papers were to approximate these principles , there would be a marked improvement in the quality of r and omized control trials . Finally , a reasonable st and ard design and conduct of trials will facilitate the interpretation of those with conflicting results and help in making valid combinations of undersized trials Purpose In this prospect i ve , r and omized , double-blind study , our aim was to compare the analgesic efficacy of the semi-blind approach of transversus abdominis plane ( TAP ) block with a placebo block in patients undergoing unilateral inguinal hernia repair . Methods After receiving hospital ethical committee approval and informed patient consents , American Society of Anesthesiologists ( ASA ) I – III patients aged 18–80 were enrolled in the study .  St and ard anesthesia monitoring was applied to all patients . After premedication , spinal anesthesia was administered to all patients with 3.5 mL heavy bupivacaine at the L3-L4 subarachnoid space . Patients were r and omly allocated into 2 groups . Group I ( n = 32 ) received a placebo block with 20 mL saline , Group II ( n = 32 ) received semi-blind TAP block with 0.25 % bupivacaine in 20 mL with a blunt regional anesthesia needle into the neurofascial plane via the lumbar triangle of Petit near the midaxillary line before fascial closure . At the end of the operation , intravenous ( IV ) dexketoprofen was given to all patients . The verbal analog scale ( VAS ) was recorded at 2 , 4 , 6 , 12 , and 24 hours postoperatively . Paracetamol IV was given to patients if their VAS score > 3 . A rescue analgesic of 0.05 mg/kg morphine IV was applied if VA S > 3 . Total analgesic consumption and morphine requirement in 24 hours were recorded . Results TAP block reduced VAS scores at all postoperative time points ( P < 0.001 ) . Postoperative analgesic and morphine requirement in 24 hours was significantly lower in group II ( P < 0.01 ) . Conclusion Semi-blind TAP block provided effective analgesia , reducing total 24-hour postoperative analgesic consumption and morphine requirement in patients undergoing elective unilateral inguinal hernia repair CONTEXT The transversus abdominis plane ( TAP ) block is a new regional anaesthesia technique applicable to infants and children . OBJECTIVE ( S ) The present study was design ed to evaluate the analgesic efficacy of ultrasound-guided TAP block with high volume local anaesthetic ( 0.5 ml kg−1 ) during the first 24 h after surgery in children undergoing inguinal hernia repair . DESIGN R and omised comparative study . SETTING Gaziantep University Hospital between December 2010 and May 2011 . PATIENTS OR OTHER PARTICIPANTS Fifty-seven children between 2 and 8 years of age undergoing unilateral inguinal hernia repair were r and omised to TAP block ( group T , n = 29 ) or to wound infiltration ( group C , n = 28 ) . INTERVENTION(S ) A TAP block using ultrasound guidance with 0.25 % levobupivacaine 0.5 ml kg−1 or wound infiltration with 0.2 ml kg−1 0.25 % levobupivacaine , was performed on the same side as the hernia under general anaesthesia . MAIN OUTCOME MEASURES Time to first analgesic , cumulative number of doses of analgesic , pain scores and adverse effects were assessed over the course of 24 h. RESULTS The time to first analgesic ( mean ± SD ) was significantly longer in group T than in group C ( 17 ± 6.8 vs. 4.7 ± 1.6 h , respectively ; P < 0.001 ) . Thirteen ( 45 % ) patients in group T did not require any analgesic within the first 24 h. The cumulative number of doses of analgesic was significantly lower in group T than in group C ( 1.3 ± 1.2 vs. 3.6 ± 0.7 , respectively , P < 0.001 ) . Pain scores were significantly different between the groups at all time points except at 1 , 20 and 24 h ( P < 0.001 ) . CONCLUSION Ultrasound-guided TAP block with high volume ( 0.5 ml kg−1 ) 0.25 % levobupivacaine provides prolonged postoperative analgesia and reduced analgesic use without any clinical side-effects after unilateral hernia repair in children . TRIAL REGISTRATION ACTRN12611000585921 ( 7/06/2011 ) from Australian New Zeal and Clinical Trials Registry BACKGROUND After renal transplantation , postoperative pain is usually mild to moderate . Postoperative pain is a concern and administration of systemic analgesic may be difficult because of underlying co-morbidities and variable responses of the graft . The transversus abdominis plane ( TAP ) block is one of the different approaches for postoperative pain relief following abdominal surgeries . We evaluated analgesic efficacy of TAP block on early postoperative pain by numeric rating scale ( NRS ) and morphine consumption during the first 24 hours after kidney transplantation . METHODS Forty-four patients , scheduled as kidney recipients were r and omized into two equal groups and were anesthetized with the same technique . After the induction of anesthesia , 15 mL of 0.25 % Bupivacaine plus 5 μ/ml epinephrine or saline was deposited into the transversus abdominis neuro-fascial plane on the side of surgery by ultrasound guide . Each patient was assessed by a blinded investigator using NRS at 1st , 4th , 8th , 12th , and 24th hour postoperatively . RESULTS Demographic data were not significantly different between the study groups . There was significant difference in median of NRS score measured at all time points in the study groups ( P < 0.001 ) . The 24-hour morphine consumption ( mean ± SD ) was 10.8 ± 9.5 mg in bupivacaine group compared with 41.2 ± 3.8 mg in the saline group ( P = 0.001 ) . There was statistically significant reduction in intraoperative fentanyl consumption in the TAP group 120 ± 20 μg compared to the control group 358 ± 24 μg ( P = 0.001 ) . In study group 4 patients and in control group 90 patients received morphine titration for pain relief ( P = 0.03 ) . There was no complication in the study groups related to nerve block . Only two patients in saline group had nausea ( P = 0.07 ) . None of our patients received any other oral or IV rescue medication . CONCLUSION Ultrasound TAP block can reduce postrenal transplantation pain and the amount of opioids consumption intraoperatively and during the first 24 hours after surgery in kidney recipients BACKGROUND : Laparoscopic cholecystectomy is associated with postoperative pain of moderate intensity in the early postoperative period . Recent r and omized trials have demonstrated the efficacy of transversus abdominis plane ( TAP ) block in providing postoperative analgesia after abdominal surgery . We hypothesized that a TAP block may reduce pain while coughing and at rest for the first 24 postoperative hours , opioid consumption , and opioid side effects in patients undergoing laparoscopic cholecystectomy in day-case surgery . METHODS : In this r and omized , double-blind study , 80 patients undergoing laparoscopic cholecystectomy in our day-case surgery unit were allocated to receive either bilateral ultrasound-guided posterior TAP blocks ( 20 mL 0.5 % ropivacaine ) or placebo blocks . Postoperative pain treatment consisted of oral acetaminophen 1000 mg × 4 , oral ibuprofen 400 mg × 3 , IV morphine ( 0–2 hours postoperatively ) , and oral ketobemidone ( 2–24 hours postoperatively ) . The primary outcome was postoperative pain scores while coughing calculated as area under the curve for the first 24 postoperative hours ( AUC/24 h ) . Secondary outcomes were pain scores at rest ( AUC/24 h ) , opioid consumption , and side effects . Patients were assessed 0 , 2 , 4 , 6 , 8 , and 24 hours postoperatively . Group-wise comparisons of visual analog scale ( VAS ) pain ( AUC/24 h ) were performed with the 2- sample t test . Morphine and ketobemidone consumption were compared with the Mann-Whitney test for unpaired data . Categorical data were analyzed using the & khgr;2 test . RESULTS : The primary outcome variable , VAS pain scores while coughing ( AUC/24 h ) , was significantly reduced in the TAP versus the placebo group ( P = 0.04 ) ; group TAP : 26 mm ( SD 13 ) ( weighted average level ) versus group placebo : 34 ( 18 ) ( 95 % confidence interval ) : 0.5–15 mm ) . VAS pain scores at rest ( AUC/24 h ) showed no significant difference between groups . Median morphine consumption ( 0–2 hours postoperatively ) was 7.5 mg ( interquartile range : 5–10 mg ) in the placebo group compared with 5 mg ( interquartile range : 0–5 mg ) in the TAP group ( P < 0.001 ) . The odds ratio of a r and om patient in group TAP having less morphine consumption than a r and om patient in group placebo was P ( group TAP < group placebo ) = 0.26 ( confidence interval : 0.15 , 0.37 ) where 0.5 represents no difference between groups . There were no between-group differences in total ketobemidone consumption , levels of nausea and sedation , number of patients vomiting , or consumption of ondansetron . CONCLUSIONS : TAP block after laparoscopic cholecystectomy may have some beneficial effect in reducing pain while coughing and on opioid requirements , but this effect is probably rather small Background : The transversus abdominis plane block is a promising approach to the provision of postoperative analgesia following abdominal incision . This effective method blocks the sensory nerve supply to the anterior abdominal wall . The authors evaluated its 
    Output:
    
Conclusion TAP block and LAI provide comparable short-term postoperative analgesia , but TAP block has better long-lasting effect