***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: Outpatient surgery benefits patients only if postoperative sequelae are effectively treated . After  laparoscopic tubal ligation ( TL )  intense pain and consequent postoperative nausea and vomiting ( PONV ) has been a problem delaying recovery and result ing in hospital admission The use of local anaesthetic has been shown to reduce the incidence of pain after laparoscopic sterilisation and the need for opioid analgesia from day surgery . We investigated a technique in which a catheter is placed in the pouch of Douglas allowing repeated administration of local anaesthetic in the postoperative period . Forty patients were r and omly allocated pre‐operatively into one of two groups to receive in a double‐blind manner either lignocaine 1 % or normal saline . Pain was assessed using visual analogue and subjective scoring systems . Postoperative pain scores were significantly reduced ( p < 0.05 ) after injection of lignocaine through the catheter . There were no complications related to the technique and no evidence of local anaesthetic toxicity .  Lignocaine instilled into the Pouch of Douglas is an effective method for postoperative pain relief after laparoscopic sterilisation OBJECTIVE The intraperitoneal route of analgesia has been studied over the years for effective perioperative pain relief during minimally invasive surgery , but there were conflicting reports of the use of intraperitoneal analgesic administration and moreover there was no consensus regarding the dose and type of drugs used . We report a r and omized trial to assess the safety and effectiveness of intraperitoneal lignocaine as an intraoperative and postoperative analgesic in laparoscopic tubal ligation . STUDY DESIGN This is a double masked , r and omized parallel group placebo-controlled trial of women seeking laparoscopic sterilization under local anaesthesia at a university hospital . The intervention group and placebo group received 20 ml of 0.5 % lignocaine and 20 ml of isotonic saline intraperitoneally respectively . Allocation concealment was done by fixed block r and omization . The participating women , the surgeon , anaesthetist , technician and the doctor who assessed the pain score were masked to the type of intervention . Intraoperative and postoperative pain was assessed by visual analogue pain scale and the scores are expressed as mean difference ( 95 % confidence interval ) between groups . Our trial is registered with the Clinical Trials Registry , India ( http://www.ctri.nic.in/ , CTRI/2009/091/000072 ) . RESULTS Out of 200 women recruited , 196 were available for final analysis with 98 women in each arm . The mean difference in the intraoperative pain score at the time of tubal ligation was 3.5 cm ( 95 % CI 2.91 - 4.09 ) . The mean difference in the postoperative pain scores at half an hour was 2.9 ( 95 % CI 2.50 - 3.44 ) , 1h was 2.5 ( 95 % CI 2.08 - 3.00 ) and 3h was 1.2 ( 95 % CI 0.75 - 1.76 ) . There was no case of adverse reaction to lignocaine . CONCLUSION Our findings show that intraperitoneal instillation of lignocaine is a safe and effective method for perioperative pain relief during laparoscopic tubal occlusion performed under conscious sedation Narcotic requirements in 51 day-surgery patients following laparoscopic tubal occlusion were significantly reduced ( P less than .01 ) by the use of 1 % etidocaine 5 mL , dropped on each fallopian tube from uterus to fimbrias before tubal b and ing when compared with a control group of 51 day-surgery patients who had no topical anesthetic agent .  All patients received general anesthesia . Although there was no significant difference in nausea rate , the incidence of vomiting was decreased . Eight of 51 patients ( 16 % ) having topical etidocaine and 19 of 51 ( 37 % ) who had no etidocaine  vomited during the postoperative period . The frequency of overnight stay was significantly reduced in the topical etidocaine group of patients ( P less than or equal to .01 ) Objective To investigate the efficacy of applying 10 ml bupivacaine 0.5%versus normal saline to the fallopian tubes under direct vision during day case laparoscopic sterilisation under general anaesthesia OBJECTIVES To determine the minimum clinical ly significant difference in visual analog scale ( VAS ) pain scores for acute pain in the ED setting and to determine whether this difference varies with gender , age , or cause of pain . METHODS A prospect i ve , descriptive study of 152 adult patients presenting to the ED with acute pain . At presentation and at 20-minute intervals to a maximum of three measurements , patients marked the level of their pain on a 100-mm , nonhatched VAS . At each follow-up they also gave a verbal rating of their pain as " a lot better , " " much the same , " " a little worse , " or " much worse . " The minimum clinical ly significant difference in VAS pain scores was defined as the mean difference between current and preceding scores when pain was reported as a little worse or a little better . Data were compared based on gender , age more than or less than 50 years , and traumatic vs nontraumatic causes of pain . RESULTS The minimum clinical ly significant difference in VAS pain scores is 9 mm ( 95 % CI , 6 to 13 mm ) . There is no statistically significant difference between the minimum clinical ly significant differences in VAS pain scores based on gender ( p=0.172 ) , age ( p=0.782 ) , or cause of pain ( p=0.84 ) . CONCLUSIONS The minimum clinical ly significant difference in VAS pain scores was found to be 9 mm . Differences of less than this amount , even if statistically significant , are unlikely to be of clinical significance . No significant difference in minimum significant VAS scores was found between gender , age , and cause-of-pain groups Bupivacaine infiltration of the mesosalpinx was compared to lidocaine , normal saline or no injection for pain relief in women having elective laparoscopic tubal sterilization by Yoon fallopian ring application , One hundred women were assigned r and omly to four groups . In a double-blind study , the mesosalpinx was infiltrated in three groups : Group I - lidocaine one per cent ; Group II - bupivacaine 0.5 per cent ; Group III - normal saline . Group IV ( control ) received no injection .  Pain intensity was reported at four study times by the patients on a self- assessment pain intensity scale . Responses were compared using the Kruskall-Wallis H-Test and Wilcoxen ’s Rank-Sum Test . Both tests indicated significant differences in pain intensity levels at various study times . The amount of supplemental fentany I given was used as a secondary measure of effectiveness . One-way analysis of variance ( ANOVA ) and Duncan ’s Multiple-Range Test showed the bupivcaine group to receive significantly less fentanyl ( p < 0.05 ) in the postanesthesia care unit . RésuméOn a comparé ľinfiltration de bupivacaine dans le mésosalpinx , è celle de la lidocaïne , du salin normal ou è aucune injection pour le soulagement de la douleur chez des femmes subissant une laparoscopie élective pour stérilisation tuhaire par anneaux de trompes de Yoon . On a réparti de façon aléatoire , 100 femmes en quatre groupes . Dans une étude è double insu , on a infiltré le mésosalpinx dans trois groupes : Groupe 1 - 1.0 pour cent de lidocaïne ; Group II-0.5 pour cent de bupivacaine ; Groupe III-salin normal . Le groupe IV ( groupe-témoin ) n’a pas reçu ď injection . Les patients ont rapporté ľintensité de leur douleur è quatre moments dans ľétude , en faisant une évaluation personnelle sur une échelle ďintensité de la douleur . On a comparé les réponses en utilisant le test H Kruskall-Wallis et le test de somme des rangs de Wilcoxen . Les deux tests démontraient des différences significatives dans les niveaux ďintensité de la douleur , è différents moments de ľétude . La quantité de fentanyl supplémentaire donnée a été utilisée comme mesure secondaire de ľefficacité . Une analyse de variance unidirectionnelle ( ANOVA ) et le , test è écarts multiples de Duncan ont démontré que le groupe bupivacaine recevait significativement moins de fentanyl ( p < 0.05 ) dans ľunité des soins postanesthésiques Objective To evaluate the efficacy of injecting 1 % lignocaine into the subserosal aspect of the cornual end of the fallopian tubes to control post‐operative pain after laparoscopic Filshie clip application Purpose To determine the incidence , the reasons , and the predictive factors for unanticipated admission after ambulatory surgery . Methods Preoperative , intraoperative , and postoperative data were collected prospect ively on 15,172 consecutive ambulatory surgical patients during a 32-month period . The data were built into a statistical model , and predictive factors were identified and classified . Results The overall incidence of unanticipated admission was 1.42 % . Admitted patients were more likely to be older , male , and ASA status II or III . Duration of anaesthesia was longer , and surgery was more likely to be completed after 3 pm . Length of stay in the Postanaesthesia Care Unit and the Ambulatory Surgery Unit was longer . Surgical reasons were cited in 38.1 % of admitted patients ; anaesthesia-related reasons were cited in 25 % ; social reasons accounted for 19.5 % , and medical reasons for 17.2 % . Ear , nose and throat ( ENT ) patients had the highest unanticipated admission rate ( 18.2 % ) , followed by urology ( 4.8 % ) and chronic pain block ( 3.9 % ) . Gynaecological patients had the lowest rate ( 0.4 % ) . Among the predictive factors found were male , ASA status II and III , long duration of surgery , surgery finishing after 3 pm , postoperative bleeding , excessive pain , nausea and vomiting , and excessive drowsiness or dizziness . Conclusion Earlier operating time for certain surgical procedures , screening for proper support at home , and implementation of clinical pathways to deal aggressively with problems such as pain , nausea and vomiting should decrease the incidence of unanticipated admission . RésuméObjectifDéterminer l’incidence , les raisons et les facteurs prédictifs d’une admission non prévue à la suite d’une chirurgie ambulatoire . MéthodeLes données préopératoires , intraopératoires et postopératoires ont été recueillies pendant 32 mois de façon prospect i ve auprès de 15 172 patients consécutifs , à la suite d’une chirurgie ambulatoire . Ces données ont été intégrées à un modèle statistique et les facteurs prédictifs ont été identifiés et classifies . RésultatsL’incidence totale d’admission imprévue était de 1,42 % . Les patients admis étaient plus susceptibles d’être âgés , de sexe mâle et d’état ASA II ou III . La durée de l’anesthésie était longue et plus susceptible de se prolonger après 15 h. Les séjours à l’unité des soins postanesthésiques et à l’unité de chirurgie ambulatoire étaient prolongés . Les raisons chirurgicales ont été invoquées pour 38,1 % des patients admis ; les raisons reliées à l’anesthésie pour 25 % ; les raisons sociales pour 19,5 % et les raisons médicales pour 17,2 % . Les patients d’oto-rhino-laryngologie ( ORL ) ont présenté le plus haut taux d’admission non planifiée ( 18,2 % ) suivis des patients d’urologie ( 4,8 % ) et de ceux qui avaient reçu un bloc thérapeutique pour douleurs chroniques ( 3,9 % ) . Les patientes de gynécologie avaient le taux le plus bas ( 0,4 % ) . Parmi les facteurs prédictifs identifiés , on a trouvé le sexe mâle , l’état ASA II et III , une chirurgie de durée prolongée , une chirurgie qui se termine après 15 h , les saignements postopératoires , la douleur excessive , les nausées et les vomissements , une gr and e somnolence et des étourdissements importants . Conclusion Le fait de procéder plus tôt dans la journée à certaines interventions chirurgicales , le dépistage préalable d’un soutien approprié pour le patient à domicile et la mise en application des moyens cliniques permettant de s’occuper énergiquement des effets secondaires comme la douleur et , les nausées et vomissements devraient diminuer l’incidence de l’admission non prévue OBJECTIVE The purpose of this study was to evaluate postoperative pain after the administration of topical bupivacaine during laparoscopic sterilization with Filshie clips . STUDY DESIGN Sixty-three women who underwent laparoscopic tubal sterilization with Filshie clips were assigned r and omly to receive topical bupivacaine or placebo .  Presence of pain , pain intensity , nausea , vomiting , timing of request for pain medication , and pain medication requirements were assessed postoperatively . 
    Output:
    
The effect size was similar for the following subgroups : pain scores reported as means or medians and use of McGill compared with VAS pain scales .
A stratified analysis of trials including ring tubal ligation compared with clip tubal ligation showed the use of local anesthetic decreased pain substantially for both .
: Use of local anesthetic during laparoscopic tubal ligation substantially reduces postoperative pain up to 8 hours after surgery