***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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    Input: Background There is a need for investigating the analgesic method as part of early recovery after surgery tailored for laparoscopic colorectal cancer ( LCRC ) surgery . In this r and omized trial , we aim ed to investigate the analgesic efficacy of an inverse ‘ v ’ shaped bilateral , subfascial ropivacaine continuous infusion in LCRC surgery . Methods Forty two patients undergoing elective LCRC surgery were r and omly allocated to one of two groups to receive either 0.5 % ropivacaine continuous infusion at the subfascial plane ( n = 20 , R group ) or fentanyl intravenous patient controlled analgesia ( IV PCA ) ( n = 22 , F group ) for postoperative 72 hours . The primary endpoint was the visual analogue scores ( VAS ) when coughing at postoperative 24 hours . Secondary end points were the VAS at 1 , 6 , 48 , and 72 hours , time to first flatus , time to first rescue meperidine requirement , rescue meperidine consumption , length of hospital stay , postoperative nausea and vomiting , sedation , hypotension , dizziness , headache , and wound complications . Results The VAS at rest and when coughing were similar between the groups throughout the study . The time to first gas passage and time to first rescue meperidine at ward were significantly shorter in the R group compared to the F group ( P = 0.010 ) . Rescue meperidine was administered less in the R group ; however , without statistical significance . Other study parameters were not different between the groups . Conclusions Ropivacaine continuous infusion with an inverse ‘ v ’ shaped bilateral , subfascial catheter placement showed significantly enhanced bowel recovery and analgesic efficacy was not different from IV PCA in LCRC surgery BACKGROUND We recently described a lateral-to-medial approach for transversus abdominis plane ( LM-TAP ) block , which may permit preoperative initiation of the block . OBJECTIVE Our objective was to evaluate the feasibility of continuous LM-TAP blocks in clinical practice in comparison with thoracic epidural analgesia ( TEA ) . DESIGN A r and omised , open-label study . SETTING University Hospital , London Health Sciences Centre , London , Ontario , Canada from July 2008 to August 2012 . PATIENTS Fifty adult patients undergoing open abdominal surgery via laparotomy were allocated r and omly to receive preoperative catheter-congruent TEA or ultrasound-guided continuous bilateral LM-TAP block for 72 h postoperatively . Reasons for non inclusion were American Society of Anesthesiologists ’ physical status more than 4 , known allergy to study drugs , chronic pain/opioid dependence , spinal abnormalities or psychiatric illness . INTERVENTIONS In the TEA group ( n = 24 ) , patient-controlled epidural analgesia was maintained using bupivacaine 0.1 % with hydromorphone 10 & mgr;g ml−1 after establishment of the initial block . In the LM-TAP group ( n = 26 ) , ultrasound-guided LM-TAP catheters were inserted on each side preoperatively after a bolus of 30 ml of ropivacaine 0.5 % ( 20 ml subcostal and 10 ml subumbilical injections on both sides ) . Analgesia was maintained with an infusion of ropivacaine 0.35 % at a rate of 2 to 2.5 ml h−1 through each catheter , along with rescue intravenous patient-controlled analgesia . MAIN OUTCOME MEASURES The primary outcome was pain score on coughing 24 h after the end of surgery . Secondary outcomes were pain scores from 24 to 72 h , intraoperative and postoperative opioid consumption , time to onset of bowel movement and side effect profiles . RESULTS Mean [ 95 % confidence interval ( 95 % CI ) ] pain scores at rest ranged from 1 . 7 ( 0.9 to 2.5 ) to 2.3 ( 1.1 to 3.4 ) in TEA vs. 1.5 ( 0.7 to 2.2 ) to 2.2 ( 1.3 to 3.0 ) in LM-TAP ( P = 0.829 ) . The dynamic pain scores ranged from 2.9 ( 1.5 to 4.4 ) to 3.8 ( 2.8 to 4.8 ) in TEA vs. 3.3 ( 2.4 to 4.3 ) to 3.8 ( 2.7 to 4.9 ) in LM-TAP ( P = 0.551 ) . The variability in pain scores was lower in the LM-TAP group than in the TEA group in the first 24 h postoperatively . Patient satisfaction and other secondary outcomes were similar . CONCLUSION Continuous bilateral LM-TAP block can be initiated preoperatively and may provide comparable analgesia to TEA in patients undergoing laparotomy . CLINICAL TRIALS REGISTRY not registered because registration was not m and atory at the time of starting the trial With the adoption of enhanced recovery and emerging new modalities of analgesia after laparoscopic colorectal resection ( LCR ) , the role of epidural analgesia has been question ed . This pilot trial assessed the feasibility of a r and omized controlled trial ( RCT ) comparing epidural analgesia and use of a local anaesthetic wound infusion catheter ( WIC ) following LCR OBJECTIVES Epidural analgesia is recommended for the provision of analgesia following major abdominal surgery . Continuous local anaesthetic wound infiltration may be an effective alternative . A prospect i ve r and omized trial was undertaken to compare these two methods following open liver resection . The primary outcome was length of time required to fulfil criteria for discharge from hospital . METHODS Patients undergoing open liver resection were r and omized to receive either epidural ( EP group ) or local anaesthetic wound infiltration plus patient-controlled opiate analgesia ( WI group ) for the first 2 days postoperatively . All other care followed a st and ardized enhanced recovery protocol .  Time to fulfil discharge criteria , pain scores , physical activity measurements and complications were recorded . RESULTS Between August 2009 and July 2010 , 65 patients were r and omized to EP ( n = 32 ) or WI ( n = 33 ) . The mean time required to fulfil discharge criteria was 4.5 days ( range : 2.5 - 63.5 days ) in the WI group and 6.0 days ( range : 3.0 - 42.5 days ) in the EP group ( P = 0.044 ) . During the first 48 h following surgery , pain scores were significantly lower in the EP group both at rest and on movement . Resting pain scores within both groups were rated as mild ( range : 0 - 3 ) . There was no significant difference between the groups in time to first mobilization or overall complication rate ( 48.5 % in the WI group vs. 58.1 % in the EP group ; P = 0.443 ) . CONCLUSIONS Local anaesthetic wound infiltration combined with patient-controlled opiate analgesia reduces the length of time required to fulfil criteria for discharge from hospital compared with epidural analgesia following open liver resection . Epidural analgesia provides superior analgesia , but does not confer benefits in terms of faster mobilization or recovery Background : Effective postoperative analgesia is essential for early rehabilitation after surgery . Continuous wound infiltration ( CWI ) of local anesthetics has been proposed as an alternative to epidural analgesia ( EA ) during colorectal surgery . This prospect i ve , double-blind trial compared CWI and EA in patients undergoing elective open colorectal surgery . Methods : Fifty consecutive patients were r and omized to receive EA or CWI for 48 h. In both groups , patients were managed according to Enhanced Recovery After Surgery recommendations . The primary outcome was the dynamic pain score measured during mobilization 24 h after surgery ( H24 ) using a 100-mm verbal numerical scale . Secondary outcomes were time to functional recovery , analgesic technique-related side effects , and length of hospital stay . Results : Median postoperative dynamic pain score was lower in the EA than in the CWI group ( 10 [ interquartile range : 1.6–20 ] vs. 37 [ interquartile range : 30–49 ] , P < 0.001 ) and remained lower until hospital discharge . The median times to return of gut function and tolerance of a normal , complete diet were shorter in the EA than in the CWI group ( P < 0.01 each ) . Sleep quality was also better in the EA group , but there was no difference in urinary retention rate ( P = 0.57 ) . The median length of stay was lower in the EA than in the CWI group ( 4 [ interquartile range : 3.4–5.3 ] days vs. 5.5 [ interquartile range : 4.5–7 ] days ; P = 0.006 ) . Conclusion : Within an Enhanced Recovery After Surgery program , EA provided quicker functional recovery than CWI and reduced length of hospital stay after open colorectal surgery BACKGROUND AND OBJECTIVES Continuous wound infusion has been investigated as a method of postoperative pain control and its efficacy has been demonstrated when compared to saline infusion . The objective of this study was to compare the quality of postoperative analgesia , the use of opioids as rescue analgesia , patient satisfaction , and the incidence of complications between epidural catheter infusion of local anesthetic and opioids and continuous wound infusion of local anesthetic . METHODS Thirty-eight patients undergoing elective laparotomy under general anesthesia , r and omly divided into two groups , participated in this study . Group I ( GI ) received postoperative patient-controlled epidural analgesia ( PCEA ) with continuous infusion of ropivacaine and fentanyl , while Group II ( GII ) receive postoperative patient-controlled continuous wound catheter infusion of ropivacaine . In the postoperative period , the following parameters were assessed : quality of analgesia through the Visual Analogue Scale ; use of rescue opioids ; and adverse effects driving patient satisfaction . RESULTS Decreased pain at rest and with movements ( p < 0.05 ) and lower consumption of rescue opioids ( p < 0.05 ) were observed in GI in all intervals evaluated , as well as greater patient satisfaction in the post anesthesia care unit ( PACU ) . The incidence of complications was similar in both groups except for pruritus which prevailed in GI between 6 ( p < 0.05 ) and 24 ( p < 0.001 ) postoperative hours . CONCLUSIONS Postoperative analgesia with opioids and local anesthetics via PCEA was superior to the patient-controlled local anesthetic infusion into surgical wound . The incidence of side effects was similar in both groups Conflicting reports exist for the efficacy of intermittent wound perfusion with bupivacaine in the relief of  postoperative pain . A study was devised to assess postoperative pain relief objective ly using a Patient Controlled Analgesic Device ( PCAD ) during continuous wound perfusion with bupivacaine or saline .  Thirty consecutive patients undergoing cholecystectomy were r and omised to receive continuous postoperative wound perfusion with 0.5 % bupivacaine for 24 h followed by normal saline for a further 24 h or vice versa . During the study period , conventional analgesia was provided using a PCAD set to deliver ( and record the number of ) on-dem and bolus doses of intravenous pethidine 0.2 mg/kg at half-hourly intervals as required .  Pethidine requirements were higher on the first postoperative day , regardless of which solution was given , but bupivacaine perfusion almost halved mean linear analogue pain scores compared to those recorded with saline . Likewise , the number of bolus doses of pethidine dem and ed was reduced by an average of 68 % compared to those recorded during saline perfusion on day 1 ( P = 0.01 ) and by 82 % on day 2 ( P = 0.01 ) . When assessed by objective criteria , perfusion of surgical wounds with bupivacaine after cholecystectomy produces better pain relief than wound perfusion with saline OBJECTIVE : To evaluate in which anatomical layer ( above the fascia or below the fascia ) continuous wound infusion of local anesthetic , combined with nonsteroidal antiinflammatory drugs , through a multiorifice catheter has the best effectiveness during the first 48 hours on postoperative pain intensity after elective cesarean delivery . METHODS : Fifty-six women undergoing elective cesarean delivery under spinal anesthesia were r and omly allocated to receive 48-hour continuous wound infusion either above the fascia or below the fascia using ropivacaine and ketoprofene through a multiholed wound catheter . No other systemic analgesics were used , except for rescue patient-controlled intravenous morphine . Evaluation by a blinded investigator included visual analog scale scores at rest and at movement , morphine consumption , patient satisfaction , residual pain at 1 and 6 months , and undesirable side effects . RESULTS : Continuous wound infusion below the fascia result ed in significantly reduced pain at rest and total postoperative morphine consumption ( 15.7 mg , 95 % confidence interval 9.7–20.7 mg ) compared with wound administration above the fascia ( 26.4 mg , 95 % confidence interval 18.1–34.7 ) . No undesirable side effects or residual pain 
    Output:
    
Superiority of preperitoneal compared with subcutaneous placement was confirmed indirectly in placebo-controlled RCTs .
Preperitoneal wound catheters provided comparable pain control compared with active controls , such as epidural analgesia .
Recovery parameters , opioid consumption , incidence of hypotension , and patient satisfaction seemed to be in favor of preperitoneal wound catheters compared with active alternatives , as well as placebo .
Conclusion : Continuous wound infiltration with preperitoneal wound catheters is an effective pain modality in abdominal surgery .
Pain control is as effective as epidural analgesia , but could be favored based upon recovery parameters and patient satisfaction