***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 : 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 Several methods are performed to control the pain after a laparoscopic cholecystectomy . Recently , the transverse abdominis plane block has been proposed to compensate for the problems developed by preexisting methods . This study was design ed to evaluate the effect of the ultrasound-guided transverse abdominis plane block ( US-TAP block ) and compare efficacy according to the concentration of local analgesics in patients undergoing laparoscopic cholecystectomy . Methods Fifty-four patients undergoing laparoscopic cholecystectomy were r and omized into three groups . The patients in Group Control did not receive the US-TAP block . The patients in Group B0.25 and Group B0.5 received the US-TAP block with 0.25 % and 0.5 % levobupivacaine 30 ml respectively . After the general anesthesia , a bilateral US-TAP block was performed using an in-plane technique with 15 ml levobupivacaine on each side . Intraoperative use of remifentanil and postoperative dem and of rescue analgesics  in PACU were recorded . The postoperative verbal numerical rating scale ( VNRS ) was evaluated at 20 , 30 , and 60 min , and 6 , 12 , and 24 hr . Postoperative complications , including pneumoperitoneum , bleeding , infection , and sleep disturbance , were also checked . Results The intraoperative use of remifentanil , postoperative VNRS and the postoperative dem and of rescue analgesics were lower in the groups receiving the US-TAP block ( Group B0.25 and Group B0.5 ) than Group Control . There were no statistically or clinical ly significant differences between Group B0.25 and Group B0.5 . No complications related to the US-TAP block were observed . Conclusions The US-TAP block with 0.25 % or 0.5 % levobupivacaine 30 ml ( 15 ml on each side ) significantly reduced postoperative pain in patients undergoing laparoscopic cholecystectomy Background The increasing use of laparoscopic techniques for colorectal resections means that the issue of postoperative analgesia needs to be reassessed . This nonr and omized comparative study aim ed to assess the efficacy of the transversus abdominis plane ( TAP ) block in laparoscopic colorectal resections . Methods Prospect ively collected data from consecutive patients undergoing laparoscopic colorectal resections were used . Analgesia usage and outcome data for patients who had a TAP block and a postoperative morphine patient-controlled analgesia pump ( PCA ) were compared with those for patients who had a PCA alone . Results Data for 74 patients were used in the final analysis ( 40 TAP/PCA and 34 PCA alone ) . There was a significant reduction in overall intravenous opiate use in the TAP/PCA group ( 31.3 vs. 51.8 mg ; P = 0.03 ) . The TAP/PCA group showed a slight trend toward a shorter hospital stay ( 3 vs. 4 days ; P = 0.17 ) but no difference in postoperative complications or any other outcome measure . There was no procedure-related morbidity relating to the use of TAP blocks . Conclusions It appears that TAP blocks reduce postoperative analgesia use of patients undergoing laparoscopic colorectal resections within an enhanced recovery program , and this may have an impact on their postoperative hospital length of stay Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Fast-track surgery accelerates recovery , reduces morbidity , and shortens hospital stay . However , the benefits of laparoscopic versus open surgery remain unproven within a fast-track program . Case reports of laparoendoscopic single-site ( LESS ) colectomies are appearing with cl aims of cosmetic advantage and decreased parietal trauma . This report describes the largest case series of LESS colorectal surgery and its effects on recovery . Methods In this series , 20 consecutive unselected patients underwent LESS colorectal surgery including right hemicolectomy ( n = 3 ) , extended right hemicolectomy , high anterior resection ( n = 2 ) , low anterior resection involving total mesorectal excision ( TME ; n = 3 ) , ileocolic anastomosis ( n = 2 , including 1 redo surgery ) , colectomy and ileorectal anastomosis ( n = 4 , including 1 with ventral mesh rectopexy ) , panproctocolectomy ( n = 2 ) , proctocolectomy and ileoanal pouch ( n = 2 ) and an abdominoperineal excision of rectum . Single-port conventional instrumentation and transversus abdominus plane ( TAP ) block analgesia were used . The indications included cancer ( n = 8) , Crohn ’s disease ( n = 4 ) , ulcerative colitis ( n = 3 ) complicated diverticulosis ( n = 2 ) , and slow-transit constipation ( n = 3 ) . Eight of the patients had undergone previous surgery . Results Most of the cases ( 90 % ) were managed successfully using the LESS technique and conventional instrumentation . Two operations ( 10 % ) were converted to st and ard laparoscopy , due to insufficient theater time and an unstable port . The operative time ranged from 45 to 240 min ( median , 110 min ) . A normal diet was tolerated within 6 h by 7 patients and in 12 to 16 h ( overnight ) by 11 patients . Complications included anastomotic bleed ( n = 1 ) , ileus ( n = 2 ) , acute renal failure secondary to hyperphosphatemia and hypocalcemia ( n = 1 ) , urine retention ( n = 1 ) , and wound infection ( n = 1 ) . The median hospital stay was 46 h ( range , 7–384 h ) . Eight patients were discharged within 24 h. There was one readmission ( 5 % ) . Conclusion Laparoendoscopic single-site colorectal resection using conventional instrumentation is feasible and safe when performed by an experienced team . The LESS approach may have advantages in terms of minimal pain , cosmesis , lower costs , and faster recovery . A r and omized trial is required to confirm whether LESS offers a true patient benefit over st and ard laparoscopic resection Background The efficacy of ultrasound-guided transversus abdominis plane ( USG-TAP ) block as a part of multimodal analgesia was evaluated in morbidly obese patients undergoing laparoscopic bariatric surgery . Methods We studied 100 patients with body mass index > 35 kg/m2 . They were r and omly allocated to study ( USG-TAP ) and control groups . Pain scores at rest and on movement at various time points up to 24 postoperative hours were compared . Other parameters evaluated were patients requiring Tramazac hydrochloride ( TMZ ) as rescue analgesic , sedation score , time to ambulate , any adverse events , and patient satisfaction . Results The median visual analogue scale pain score of the study ( USG-TAP ) group was consistently lower at 1 , 3 , 6 , 12 , and 24 h at rest and on movement , in the postoperative period . Number of patients requiring TMZ  required in the first , third , and sixth hour was significantly lower in the USG-TAP group . The prolonged sedative effect of the TMZ affected the time to ambulate . Patients in the control group remained more se date d. Four patients in the control group required BIPAP support postoperatively ; no adverse event was observed . Time to ambulate was 6.3 ± 1.8 h in USG-TAP and 8 ± 1.8 h in control groups ; P < 0.001 . Patient satisfaction scores were significantly higher in the USG-TAP group ; P < 0.001 . Conclusions Our study demonstrates that the USG-TAP as part of multimodal analgesic technique in morbidly obese patients undergoing laparoscopic gastric bypass  reduces opioid requirement , improves pain score , decreases sedation , promotes early ambulation , and has greater patient satisfaction BACKGROUND The effect of adding transversus abdominis plane ( TAP ) blocks to local anaesthetic infiltration on morphine consumption and postoperative pain in children undergoing laparoscopic appendicectomy is unknown . METHODS After r and om allocation , 93 children aged 7 - 16 were r and omized to receive ultrasound-guided TAP blocks placed before surgery or not ( control ) . All subjects had port sites infiltrated with ropivacaine and were prescribed i.v . patient-controlled analgesia ( PCA ) with morphine and oral paracetamol for postoperative pain . The primary outcome was the proportion of subjects using > 200 µg kg(-1 ) morphine . Secondary outcomes included PCA morphine use , pain scores , time intervals to the first use of PCA and other analgesics , sedation scores , postoperative nausea or vomiting , and time to hospital discharge . RESULTS The procedure duration was longer in the TAP group ( 111 compared with 97 min for controls , P=0.03 ) . The duration in the recovery ward and that of the hospital stay were similar . There was no difference in the proportion of subjects requiring > 200 µg kg(-1 ) of PCA morphine [ control 31/45 ( 69 % ) , TAP 29/42 ( 69 % ) , P=0.99 ] . There was no significant difference in PCA morphine use , time intervals to the first use of PCA or other analgesics , or amounts of other analgesics . More patients in the TAP group had complicated appendicitis [ TAP 13/42 ( 31 % ) , control 5/45 ( 11 % ) , P=0.02 ] . Pain scores were reduced for the TAP group in the recovery ward only ( median score 0 vs 2 , 95 % confidence interval 0 - 3 , P=0.03 ) . CONCLUSIONS TAP blocks increased anaesthesia time by 14 min on average but offered no clinical ly important benefit over local anaesthetic port-site infiltration to paediatric patients undergoing laparoscopic appendicectomy Background Although opioids are the main choice for acute postoperative pain control , many side effects have been reported for them . NSAIDs and paracetamol have been used extens 
    Output:
    
TAP block would result in less analgesic consumption , less requirement of analgesic , and less pain at 2 h and slightly at 6 h but at 24 h after laparoscopic surgery in comparison with usual care alone or placebo block .
In addition TAP block can increase the incidence of postoperative nausea and vomiting