***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 : Both postoperative epidural analgesia and intravenous ( IV ) infusion of local anesthetic have been shown to shorten ileus duration and hospital stay after colon surgery when compared with the use of systemic narcotics alone . However , they have not been compared directly with each other . Methods : Prospect i ve , r and omized clinical trial was conducted comparing the 2 treatments in open colon surgery patients . Before induction of general anesthesia , patients were r and omized either to epidural analgesia ( bupivacaine 0.125 % and hydromorphone 6 & mgr;g/mL were started at 10 mL/hr within 1 hr of the end of surgery ) or IV lidocaine ( 1 mg/min in patients < 70 kg , 2 mg/min in patients ≥70 kg ) . Markers of return of bowel function , length of stay , postoperative pain scores , systemic analgesic requirements , and adverse events were recorded and compared between the 2 groups in an intent-to-treat analysis . Results : Study enrollment took place from April 2005 to July 2006 . Twenty-two patients were r and omized to IV lidocaine therapy and 20 patients to epidural therapy . No statistically significant differences were found between groups in time to return of bowel function or hospital length of stay . The median pain score difference was not statistically significant . No statistically significant differences were found in pain scores for any specific postoperative day or in analgesic consumption . Conclusions : No differences were observed between groups in terms of return of bowel function , duration of hospital stay , and postoperative pain control , suggesting that IV infusion of local anesthetic may be an effective alternative to epidural therapy in patients in whom epidural anesthesia is contraindicated or not desired Objective : To characterize the beneficial effects of perioperative systemic lidocaine on length of hospital stay , gastrointestinal motility , and the inflammatory response after colorectal surgery . Summary Background Data : Surgery-induced stimulation of the inflammatory response plays a major role in the development of several postoperative disorders . Local anesthetics possess anti-inflammatory activity and are thought to positively affect patients ' outcome after surgery . This double-blinded , r and omized , and placebo-controlled trial aim ed to evaluate beneficial effects of systemic lidocaine and to provide insights into underlying mechanisms . Methods : Sixty patients undergoing colorectal surgery , not willing or unable to receive an epidural catheter , were r and omly assigned to lidocaine or placebo treatment . Before induction of general anesthesia , an intravenous lidocaine bolus ( 1.5 mg/kg ) was administered followed by a continuous lidocaine infusion ( 2 mg/min ) until 4 hours postoperatively . Length of hospital stay , gastrointestinal motility , and pain scores were recorded and plasma levels or expression of pro- and anti-inflammatory mediators determined . Results : Lidocaine significantly accelerated return of bowel function and shortened length of hospital stay by one day . No difference could be observed in daily pain ratings . Elevated plasma levels of IL-6 , IL-8 , complement C3a , and IL-1ra as well as expression of CD11b , l- and P-selectin , and platelet-leukocyte aggregates were significantly attenuated by systemic lidocaine . Conclusions : Perioperative intravenous lidocaine not only improved gastrointestinal motility but also shortened length of hospital stay significantly . Anti-inflammatory activity modulating the surgery-induced stress response may be one potential mechanism . Systemic lidocaine may thus provide a convenient and inexpensive approach to improve outcome for patients not suitable for epidural anesthesia Background Postoperative ileus is a common condition after abdominal surgery . Many prokinetic drugs have been evaluated including osmotic laxatives . The data on colon-stimulating laxatives are scarce . This prospect i ve , r and omized , double-blind trial investigates the effect of the colon-stimulating laxative bisacodyl on postoperative ileus in elective colorectal resections . Material s and methods Between November 2004 and February 2007 , 200 consecutive patients were r and omly assigned to receive either bisacodyl or placebo . Primary endpoint was time to gastrointestinal recovery ( mean time to first flatus passed , first defecation , and first solid food tolerated ; GI-3 ) . Secondary endpoints were incidence and duration of nasogastric tube reinsertion , incidence of vomiting , length of hospital stay , and visual analogue scores for pain , cramps , and nausea . Results One hundred sixty-nine patients were analyzed , and 31 patients discontinued the study . Groups were comparable in baseline demographics . Time to GI-3 was significantly shorter in the bisacodyl group ( 3.0 versus 3.7 days , P = 0.007 ) . Of the single parameters defining GI-3 , there was a 1-day difference in time to defecation in favor to the bisacodyl group ( 3.0 versus 4.0 days , P = 0.001 ) , whereas no significant difference in time to first flatus or tolerance of solid food was seen . No significant difference in the secondary endpoints was seen . Morbidity and mortality did not differ between groups . Conclusion Bisacodyl accelerated gastrointestinal recovery and might be considered as part of multimodal recovery programs after colorectal surgery The postoperative period is associated with an increased production of cytokines , which augment pain sensitivity . We investigated the hypothesis that epidural clonidine premedication and postoperative patient-controlled epidural analgesia ( PCEA ) including clonidine would decrease the release of proinflammatory ( interleukin (IL)-6 , IL-1β , IL-8 , and tumor necrosis factor (TNF)-&agr ; ) and antiinflammatory ( IL-1 receptor antagonist ( RA ) ) cytokines in patients who underwent elective colorectal surgery and that they would provide better postoperative analgesia . Forty patients were r and omly assigned to 1 of 2 groups of 20 each : the control group received normal saline 10 mL , whereas the clonidine group received epidural clonidine 150 μg diluted with 9 mL of normal saline 30 min before surgery . Venous blood sample s for cytokine levels were obtained before induction , at the end of surgery , and after surgery at 12 and 24 h. After surgery , the clonidine group patients received PCEA with morphine ( 0.1 mg/mL ) and clonidine ( 1.5 μg/mL ) in 0.2 % ropivacaine 100 mL , whereas control group patients received only PCEA morphine and ropivacaine . Patients in the clonidine group exhibited longer PCEA trigger times , lower pain scores at rest and while coughing , less morphine consumption , and a faster return of bowel function throughout the 72-h postoperative observation period , compared with patients in the control group . For patients in the clonidine group , production of IL-1RA , IL-6 , and IL-8 was significantly less increased at the end of the surgical procedure and at 12 and 24 h after surgery . However , the concentrations of IL-1β and TNF-&agr ; were not significantly increased BACKGROUND Studies have shown the value of using fast-track postoperative recovery . St and ard procedures ( non-fast-track strategies ) remain in common use for perioperative care . Few prospect i ve reports exist on the outcome of fast-tracking in Central Europe . The aim of our study was to assess the effect and safety of our own fast-track protocol with regard to the postoperative period after open bowel resection . PATIENTS AND METHODS One hundred and five patients with ASA score I-II scheduled for open intestinal resection in the period April 2005-December 2007 were r and omly selected for the fast-track group ( FT ) and non-fast-track group ( non-FT ) . A design ed protocol was used in the FT group with the emphasis on an interdisciplinary approach . The control group ( non-FT ) was treated by st and ard established procedures .  Postoperative pain , rehabilitation , gastrointestinal functions , postoperative complications , and post-op length of stay were recorded . RESULTS Of 105 patients , 103 were statistically analyzed . Patients in the FT group ( n=51 ) and non-FT group ( n=52 ) did not differ in age , surgical diagnosis , or procedure . The fast-track procedure led to significantly better control of postoperative pain and faster restoration of GI functions ( bowel movement after 1.3 days vs. 3.1 , p<0.001 ) . Food tolerance was significantly better in the FT group and rehabilitation was also faster . Hospital stay was shorter in the FT group - median seven days ( 95 % CI 7.0 - 7.7 ) versus ten days ( 95 % CI 9.5 - 11.3 ) in non-FT ( p<0.001 ) . Postoperative complications within 30 postoperative days were also significantly lower in the FT group ( 21.6 vs. 48.1 % , p=0.003 ) . There were no deaths and no patients were readmitted within 30 days . CONCLUSIONS Following the FT protocol helped to reduce frequency of postoperative complications and reduced hospital stay . We conclude that the FT strategy is safe and effective in improving postoperative outcomes Background Preoperative mechanical bowel preparation can be question ed as st and ard procedure in colon surgery , based on the result from several r and omised trials . Methods As part of a large multicenter trial , 105 patients planned for elective colon surgery for cancer , adenoma , or diverticulitis in three hospitals were asked to complete a question naire regarding perceived health including experience with bowel preparation . There were 39 questions , each having 3 – 10 answer alternatives , dealing with food intake , pain , discomfort , nausea/vomiting , gas distension , anxiety , tiredness , need of assistance with bowel preparation , and willingness to undergo the procedure again if necessary . Results 60 patients received mechanical bowel preparation ( MBP ) and 45 patients did not ( No-MBP  ) . In the MBP group 52 % needed assistance with bowel preparation and 30 % would consider undergoing the same preoperative procedure again . In the No-MBP group 65 % of the patients were positive to no bowel preparation . There was no significant difference between the two groups with respect to postoperative pain and nausea . On Day 4 ( but not on Days 1 and 7 postoperatively ) patients in the No-MBP group perceived more discomfort than patients in the MBP group , p = 0.02 . Time to intake of fluid and solid food did not differ between the two groups . Bowel emptying occurred significantly earlier in the No-MBP group than in the MBP group , p = 0.03 . Conclusion Mechanical bowel preparation is distressing for the patient and associated with a prolonged time to first bowel emptying The aim of this trial was to compare  multimodal optimization  with  conventional perioperative management  in a consecutive series of patients undergoing a wide range of colorectal procedures Background Fast-track protocol s are followed by an enhanced recovery , early return to bowel function and to complete nutrition , and a reduced hospital stay . Our study was design ed to implement fast-track protocol in our university hospital . Methods The 96 consecutive patients with colorectal neoplasm included in the study were r and omized in two equal groups : group 1 ( FT ) included patients undergoing colorectal surgery in a fast-track protocol , and group 2 ( C ) included patients undergoing colorectal surgery with a conventional care protocol .  As with other fast-track protocol s , our protocol included carbohydrate fluids load before operation , early mobilization and oral feeding , regular prokinetics , and multimodal postoperative analgesia .  Time to restoration of bowel function , to complete mobilization and feeding , length of hospital stay , and incidence of complications and readmissions were monitored . Results Time to mobilization , restoring of bowel function , and complete oral feeding were significantly shorter with fast-track protocol ( p = 0.001 , p = 0.042 , and p = 0.01 , respectively ) . Hospital stay also was shorter in the fast-track group ( p = 0.001 ) . The incidence of complications did not significantly differ with the study groups . Conclusions In our study , fast-track protocol result ed in a shorter time to mobilization , complete feeding , and discharge from hospital . Fast-track protocol did not increase the incidence of complications . However , we consider that our data require further confirmation with powered multicenter national studies BACKGROUND Evidence -based guidelines on optimal perioperative fluid management have not been established , and recent r and omized trials in major abdominal surgery suggest that large amounts of fluid may increase morbidity and hospital stay . However , no information is available on detailed functional outcomes or with fast-track surgery . Therefore , we investigated the effects of two regimens of intraoperative fluids with physiological recovery as the primary outcome measure after fast-track colonic surgery . METHODS In a double-blind study , 32 ASA I-III patients undergoing elective colonic surgery were r and omized to ' restrictive ' ( Group 1 ) or ' liberal ' ( Group 2 ) perioperative fluid administration .  Fluid algorithms were based on fixed rates of crystalloid infusions and a st and ardized volume of colloid .  Pulmonary function ( spirometry ) was the primary outcome measure , with secondary outcomes of exercise capacity ( submaximal exercise test ) , orthostatic tolerance , cardiovascular hormonal responses , postoperative ileus ( transit of radio-opaque markers ) , postoperative nocturnal hypoxaemia , and overall recovery within a well-defined multimodal , fast-track recovery programme . Hospital stay and complications were also noted 
    Output:
    
Recovery of gastrointestinal motility was accelerated when one of the following forms of treatment was administered : probiotics , early feeding in combination with multimodal regimens , pentoxifylline , flurbiprofen , valdecoxib , ketorolac , clonidine , ropivacaine , lidocaine or spinal analgesia .
Gum chewing , preoperative carbohydrate loading , bisacodyl and Doppler-guided fluid management have an uncertain effect on bowel motility .
The use of nonpharmacological interventions , intrathecal morphine , restricted fluid therapy and choline citrate yielded no significant acceleration in bowel motility .
CONCLUSIONS A multimodal treatment , where the use of morphine is restricted , seems to be the best way to accelerate the recovery of gastrointestinal bowel motility .
RELEVANCE TO CLINICAL PRACTICE The early return of bowel functions leads to quicker overall postoperative recovery , which may ease patient discomfort and decrease hospitalisation costs