***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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    ***EXAMPLES*** 
    Input: In order to assess the effect of spinal clonidine on tourniquet pain , 30 patients scheduled to undergo orthopaedic surgery under spinal anaesthesia were allocated r and omly to two groups . Patients in group I ( n = 15 ) received 0.5 % isobaric bupivacaine 15 mg plus isotonic saline 1 ml . Patients in group II ( n = 15 ) received 0.5 % bupivacaine 15 mg plus clonidine 1 ml ( 150 micrograms ) . Sensory block was evaluated by pinprick and motor block with Bromage 's scale . The presence of clonidine significantly prolonged the duration of sensory and motor block . Three patients in group I , but none in group II , experienced tourniquet pain . Hypotension and bradycardia were not worsened by spinal clonidine . The use of clonidine may be a useful technique to augment bupivacaine spinal block Objective . To determine whether 1 mg morphine injected intravenously in conjunction with prilocaine has any effect on postoperative pain and analgesic requirement during intravenous regional anesthesia . Methods . This was a r and omized , double-blind study that included 37 patients undergoing carpal tunnel operations of the h and under intravenous regional anesthesia . Either 1 ml of morphine or 1 ml of physiologic saline diluted to 5 ml with 5 % glucose was injected into the isolated exsanguinated arm . This was followed by 3 mg/kg of 0.5 % prilocaine ( total volume , 30 - 50 ml ) . Pain was assessed at 30 , 60 , 90 , and 120 minutes , and 8 , 24 , and 48 hours after the end of the operation using a linear visual analog scale ( VAS ) . The total number of analgesic tablets consumed in the first 48 hours were also counted . Results . No difference was found in the VAS pain scores between the groups at any of the time periods studied . The postoperative analgesic requirement was similar in both groups . Conclusion . The authors conclude that 1 mg morphine showed no effect on postoperative pain or analgesic requirements when given in conjunction with prilocaine during intravenous regional anesthesia The effect of the addition of 0.1 mg or 0.2 mgfentanyl to 40 ml 0.5 % prilocaine in intravenous regional anaesthesia of the arm was investigated in 37 patients in a r and omised , double‐blind study . The characteristics of the sensory and motor block were studied . There was no difference in the speed of onset of analgesia in the groups ( mean latency approximately 4 min in each group ) . However , significantly more patients in thefentanylO.2 mg group ( 7/12 ) had complete anaesthesia at 15 min than in the fentanyl 0.1 mg group ( 1/13 ) and the control group ( 2/12 ) ( p < 0.05 ) . There were no differences in the incidence of tourniquet pain immediately before cuff deflation ( tourniquet time 45–87 min ) . After cuff deflation , in those patients who complained of wound pain within 30 min , on average the pain appeared later in the fentanyl 0.2 mg group ( six patients , mean 14.3 min ) than in the control group ( eight patients , mean 9.4 min ) ( ns ) . In the fentanyl groups , the incidence of central nervous system side effects was greater than in the control group ( fentanyl 0.1 mg 7/13 patients , fentanyl 0.2 mg 6/12 patients , control 1/12 patients ) ( p < 0.05 ) . The plasma concentrations of prilocaine  after cuff deflation were higher , in a dose‐dependent fashion , in the fentanyl groups than in the control group , but the concentrations of prilocaine and fentanyl did not correlate with the symptoms . Postoperative nausea occurred only in the patients who had received fentanyl We have compared in two groups of five healthy volunteers , the motor effect of prilocaine i.v . regional anaesthesia of the forearm with and without addition of mivacurium 0.6 mg . Although addition of mivacurium might , theoretically , provide the benefit of increased neuromuscular block with rapid plasma cholinesterase degradation in the isolated limb , we observed prolonged forearm weakness in the  mivacurium group using tests of grip strength ( median recovery to 90 % of control , 80 min ( range 60 min to > 8 h ) vs control median recovery to 90 % of 16 ( 8 - 24 ) min ) and bead transfer ( median recovery to 90 % of control 36 ( 24 - 48 ) min vs control median recovery to 90 % of 12 ( 8 - 16 ) min ) . This weakness was considerably in excess of that predicted by rapid systemic degradation of mivacurium . The mivacurium group experienced symptoms of local anaesthetic toxicity which did not occur in the control group and which could not be replicated by administration of mivacurium alone BACKGROUND Clonidine has been added to local anesthetic regimens for various peripheral nerve blocks , result ing in prolonged anesthesia and analgesia . The authors postulated that using clonidine as a component of intravenous regional anesthesia ( IVRA ) would enhance postoperative analgesia . METHODS Forty-five patients undergoing ambulatory h and surgery received IVRA with lidocaine , 0.5 % , and were assigned r and omly and blindly to three groups . The control group received intravenous saline , the intravenous clonidine group received 1 microg/kg clonidine intravenously , and the IVRA clonidine group received 1 microg/kg clonidine as part of the IVRA solution . After their operations , the patients ' pain and sedation scores and analgesic use were recorded . RESULTS Patients in the IVRA clonidine group had a significantly longer period of subjective comfort when they required no analgesics ( median [ range ] ) for 460 min ( 215 - 1,440 min ) , compared with 115 min ( 14 - 390 min ) for the control group and 125 min ( 17 - 295 min ) for the intravenous clonidine group ( P<0.0001 ) . The patients who received IVRA with clonidine reported significantly lower pain scores 1 and 2 h after tourniquet deflation compared with the other groups , and they required no fentanyl in the postanesthesia care unit . They also required fewer analgesic tablets ( 325 mg acetaminophen with 30 mg codeine ) in the first 24 h ( 2+/-1 , mean + /- SD ) compared with the other two groups , 5+/-1 tablets ( control ) and 4+/-2 tablets ( intravenous clonidine ) ( P<0.0001 ) . No significant postoperative sedation , hypotension , or bradycardia developed in any of the patients . CONCLUSION The addition of 1 microg/kg clonidine to lidocaine , 0.5 % , for IVRA in patients undergoing ambulatory h and surgery improves postoperative analgesia without causing significant side effects during the first postoperative day In a double‐blind , r and omised study , we have examined the effects of the addition of pethidine 100 mg to 40 ml prilocaine 0.25 % for intravenous regional anaesthesia in healthy volunteers . During intravenous regional anaesthesia the h and and forearm are isolated from the rest of the circulation and pethidine interaction with central opiate receptors does not occur . Pethidine increased the speed of onset and extent of sensory and motor block , reduced tourniquet and forearm pain , and subjectively improved the quality of the block .  Pethidine has local anaesthetic action on peripheral nerves in vivo Eighty unpremedicated patients undergoing day‐case h and surgery under intravenous regional anaesthesia were r and omly allocated to receive , in a double‐blind study , either 40 ml 0.75 % prilocaine hydrochloride , with 5 ml 8.4 % sodium bicarbonate or 5 ml 0.9 % saline . The alkalinised group had significantly less pain on injection ( p = 0.0045 ) , during surgery ( p = 0.0074 ) and 5 minutes after the tourniquet was deflated ( p = 0.0027 ) . The time elapsed between insertion of the block and commencement of surgery was not affected UNLABELLED Intravenous regional anesthesia ( IVRA ) with meperidine in doses > or = 100 mg provides effective postoperative analgesia . However , this technique is associated with excessive opioid-related side effects , which limit its clinical usefulness . The minimal dose of meperidine that is effective for IVRA has yet to be established . We added 0 , 10 , 20 , 30 , 40 , or 50 mg of meperidine to 0.5 % lidocaine IVRA for either carpal tunnel or tenolysis surgery .  Pain and sedation scores and the incidence of side effects were assessed in the postanesthesia care unit . The duration of analgesia , defined as the time to first request for pain medications , and use of acetaminophen/codeine ( T3 ) tablets were measured . The duration of analgesia increased , in a dose-dependent manner , in the groups that received 0 , 10 , 20 , and 30 mg of meperidine . There was no significant difference in the duration of analgesia for patients receiving > or = 30 mg of meperidine . T3 use was similar in the groups that received 0 , 10 , and 20 mg of meperidine and in the groups that received 30 , 40 , and 50 mg . T3 use was significantly lower in the larger dose groups . The incidence of sedation and of all other side effects was significantly higher in the groups that received 30 - 50 mg of meperidine compared with those that received smaller doses . We conclude that doses of meperidine large enough to produce the most effective postoperative analgesia with IVRA lidocaine causes a significant incidence of side effects , thus limiting its clinical usefulness . IMPLICATION S Meperidine may be a useful addition to 0.5 % lidocaine for i.v . regional anesthesia . We showed that 30 mg is the optimal dose of meperidine with respect to postoperative analgesia . However , this dose caused a significant incidence of sedation , dizziness , and postoperative nausea and vomiting In an attempt to reduce the dose of local anesthetic during intravenous ( IV ) regional anesthesia of the upper limb , we combined 100 mg of lidocaine with 0.05 mg of fentanyl and 0.5 mg of pancuronium . The study was design ed in a r and omized , double-blind fashion to determine the efficacy of this approach in providing analgesia and relaxation during surgery and to evaluate its safety after immediate deflation of the tourniquet following IV drug injection . Eighty unpremedicated patients , ASA physical status I or II , were assigned to the following groups : group A ( n = 15 ) received 100 mg of lidocaine diluted in 40 mL of NaCl IV ; groups B-D ( n = 15 in each group ) received 100 mg of lidocaine diluted in NaCl , with the addition of 0.05 mg of fentanyl ( group B ) or 0.5 mg of pancuronium ( group C ) , or both ( group D ) to a total volume in all groups of 40 mL. Patients in groups A-D underwent elective operations on the forearm , wrist , and h and ; for evaluation of safety , in 20 volunteers ( group E ) the tourniquet was immediately released after IV injection of the three drugs at the previously described doses . The analgesic effect was more profound in group D compared with groups A-C. In group D , 9 of 15 patients had excellent analgesia . In six patients , pain was experienced at the beginning of surgery , but 5 min thereafter patients remained pain free . ( ABSTRACT TRUNCATED AT 250 WORDS We have studied postoperative analgesia in 32 patients undergoing outpatient repair of inguinal hernia . All patients received a st and ardized general anaesthetic of thiopentone followed by halothane or isoflurane in 70 % nitrous oxide and oxygen delivered by face mask or laryngeal mask with spontaneous ventilation . No patient received premedication , opioids or neuromuscular blockers . Before wound closure the surgeon infiltrated 20 ml of a study solution into the wound . The solution contained ketorolac 30 mg in saline , 0.25 % bupivacaine and ketorolac 30 mg , 0.25 % bupivacaine or saline ( control group ) . The control group received ketorolac 60 mg i.m . at the same time . Pain scores were measured 2 , 6 and 24 h after operation . Pain scores for all three active groups were significantly less ( P < 0.05 ) than the control group at all times . There were no significant differences in pain scores at any time between the three study groups . Wound infiltration with ketorolac 30 mg in saline , 0.25 % bupivacaine or ketorolac 30 mg with  
    Output:
    
There is good evidence to recommend NSAIDs in general and ketorolac in particular , for improving postoperative analgesia .
Clonidine 1 μg·kg−1 also appears to improve postoperative analgesia and prolong tourniquet tolerance .
Opioids are poor by this route ; only meperidine 30 mg or more has substantial postoperative benefit but at the expense of postdeflation nausea , vomiting and dizziness .
Muscle relaxants improve intraoperative motor block and aid fracture reduction .
Conclusion Using NSAIDs or clonidine as adjuncts to IVRA improves postoperative analgesia and muscle relaxant improves motor block .
L’administration de 1μg·kg− 1 de clonidine semble améliorer l’analgésie postopératoire et la tolérance prolongée du garrot .
Les opioïdes font piètre figure dans ces circonstances ; seule une dose de 30 mg ou plus de mépéridine présente des bienfaits postopératoires substantiels , mais aux dépens de nausées , de vomissements et d’étourdissement au relâchement du garrot .
Les myorelaxants améliorent le bloc moteur peropératoire et favorisent la réduction de fracture .
Conclusion L’utilisation de AINS ou de clonidine comme traitement d’appoint de l’ARIV améliore l’analgésie postopératoire t and is que les myorelaxants améliore le bloc moteur