***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: Abstract . After laparoscopic surgery carbon dioxide remains within the peritoneal cavity for a few days , commonly causing pain . This prospect i ve r and omized study was performed to determine the efficacy of intraperitoneal infusion of normal saline on  postoperative pain after laparoscopic cholecystectomy . Altogether 300 patients were r and omly assigned to one of five groups of 60 patients each . Group A : control group , no peritoneal infusion , no subhepatic drain . Group B : no peritoneal infusion but a subhepatic closed drain was left for 24 hours . Group C : normal saline 25 to 30 ml/kg body weight at a temperature of 37 ° C was infused under the right hemidiaphragm and left in the peritoneal cavity . Group D : normal saline in a room temperature was infused under the right hemidiaphragm and suctioned after the pneumoperitoneum was deflated . Group E : normal saline was infused and suctioned as in group D , but a subhepatic closed drain was left for 24 hours . Postoperatively , analgesic medication usage , nausea , vomiting , and pain scores were determined at 2 , 6 , 12 , 24 , 48 , and 72 hours ( during hospitalization and at home ) . Postoperative pain was reduced significantly ( p < 0.001 ) in the patients of groups C , D , and E versus controls , whereas no difference was observed between groups A and B. Among groups C , D , and E , group E ( p < 0.01 ) had the best results followed by group D and then group C. Intraperitoneal normal saline offered a detectable benefit to patients undergoing laparoscopic cholecystectomy . The beneficial effect was better when the fluid was suctioned after deflation of the pneumoperitoneum and even better when a subhepatic closed drain continued fluid suction during the first postoperative hours Background : A controversy exists over the effectiveness and clinical value of intraperitoneal local anaesthetics for treating  pain after laparoscopic cholecystectomy . The use of intraperitoneal lidocaine was evaluated in this study Background Some scientific studies , with controversial results , have evaluated the efficacy in reducing pain of some different local anesthetic molecules , which were administered at different dosages and in different ways . The primary goal of this r and omized , controlled , prospect i ve study ( Clinical Trials.gov ID NCT00599144 ) was to assess the effectiveness of 0.5 % bupivacaine for pain control after video-laparoscopic cholecystectomy at its optimal dosage of 2 mg/kg infiltrated in the muscular fasciae of the trocars , or positioned in the gallbladder soaking a sheet of regenerated oxidized cellulose ( Tabotamp ® ) . Methods A total of 45 patients underwent elective video-laparoscopic cholecystectomy .  They were r and omized in three groups each made of 15 patients : group A ( bupivacaine-soaked Tabotamp ® positioned in the gallbladder bed ) , group B ( bupivacaine infiltrated in the muscular fasciae of the trocars ’ seat ) , group C ( control group , not using local anesthetic ) . Six and twenty-four hours after the intervention , the nature of the pain and its intensity were recorded with the use of a Visual Analogue Scale ( VAS ) . Results Six hours after the intervention , VAS average was 29.6 ± 10.92 for group A , 25.86 ± 16.06 for group B , and 36.13 ± 16.62 for group C. At 24 h , we recorded 19.26 ± 15.81 , 18.53 ± 12.3 , and 20.46 ± 20.08 for groups A , B , and C , respectively ( p > 0.05 ) . Comparing groups A and B between them and with the control group at 6 and 24 h , we deduced how only the first group showed a statistically significant advantage ( p < 0.05 ) in reducing visceral and shoulder pain compared with the two other groups . Wound infiltration result ed in being statistically favorable in reducing parietal pain only when compared with Group A. For groups A and B , bupivacaine significantly reduced the use of postoperative pain killers . Conclusion Bupivacaine , either infiltrated in trocars ’ wounds or kept soaked in a regenerated oxidized cellulose sheet positioned in the gallbladder bed , although safe and not economically dem and ing , can increase postoperative comfort Background The aim of this study was to test the use of preincisional and intraperitoneal levobupivacaine ( L-B ) 0.25 % in laparoscopic cholecystectomies for postoperative analgesia . Methods A total of 108 patients under general anesthesia were r and omly assigned to receive preincisional local infiltration of 20 ml solution and intraperitoneal instillation of another 20 ml solution . Group A received for local infiltration and intraperitoneal instillation normal saline ( NS ) . Group B received for local infiltration L-B 0.25 % and for intraperitoneal instillation NS . Group C received for local infiltration NS and for intraperitoneal instillation L-B 0.25 % . Group D received both for local infiltration and intraperitoneal instillation L-B 0.25 % . Abdominal and right shoulder pain were recorded for 24 h postoperatively . Results The pain scores were lower in group D than in the other groups during rest , cough , and movement ( p < 0.05 ) . Rescue analgesic treatment was significantly lower in patients of group D ( 35 % ) as compared with that of group A ( 84 % ) ( p < 0.05 ) . The incidence of right shoulder pain was significantly lower in groups C ( 22 % ) and D ( 18 % ) than in any of the other groups ( p < 0.05 ) . Conclusions The combination of preincisional local infiltration and intraperitoneal instillation of L-B 0.25 % shows an advantage for postoperative analgesia after laparoscopic cholecystectomy BACKGROUND Shoulder pain is common after  laparoscopic cholecystectomy  ( 60.5 % ) and can delay return to normal activities . The cause is unclear but may involve referral of pain from the traumatized area . PATIENTS AND METHODS A total of 75 patients with chronic cholecystitis who underwent laparoscopic cholecystectomy  were r and omized into two groups . Group I ( 37 patients ) had 10 mL of 0.25 % bupivacaine instilled into the gallbladder bed and Calot 's triangle area at the end of cholecystectomy . Group II ( 38 patients ) served as controls and had no bupivacaine instillation .  Postoperative shoulder pain was evaluated . RESULTS Six patients in Group I developed shoulder pain ( 16 % ) compared with 23 patients in Group II ( 60.5 % ) . The difference was statistically significant ( P = 0.0002 ) . CONCLUSION The raw area of the removed organ is at least partially responsible for shoulder pain after laparoscopic cholecystectomy . Local bupivacaine is effective in reducing such pain BACKGROUND Laparoscopic cholecystectomy ( LC ) has become the st and ard treatment for gall bladder disease . However , despite its low degree of invasiveness , many patients complain of postoperative pain and postoperative nausea/vomiting . This study was planned to evaluate different factors affecting the incidence and severity of postoperative shoulder-tip pain after LC . PATIENTS AND METHODS One hundred consecutive patients who were treated for gall bladder stone by LC at the Gastroenterology Surgical Center , Mansoura University , Mansoura , Egypt , during the period from October 2008 to January 2010 , were r and omized according to different pnemoperitonum pressures ( 8 , 10 , 12 , and 14 mm Hg ) . Each group comprises 25 patients . RESULTS There were 62 patients reported to have postoperative shoulder-tip pain during the first 12 hours after operation , which decreased to 9 patients on the 10th postoperative day . A significant difference was observed in the prevalence of pain at different pressures , 11 % with low pressure and increased to 20 % with high pressure . The incidence of shoulder-tip pain was significantly more in patients with a longer duration of the operation of > 45 minutes at 12 hours ( 23 [ 76.7 % ] versus 39 [ 55.7 % ] ; P = 0.04 ) , at 24 hours ( 23 [ 76.7 % ] versus 29 [ 41.4 % ] ; P = 0.009 ) , and at 3 days postoperatively ( 19 [ 63.3 % ] versus 20 [ 28.6 % ] ; P = 0.01 ) . The volume of used gases during the operation had no effect on the incidence or severity of shoulder-tip pain after LC . Also , the use of intraoperative analgesics had no effect on the incidence or severity of shoulder-tip pain after LC . CONCLUSIONS The origin of pain after LC is multifactorial . We recommend the use of the lower pressure technique during LC , and as patients with and without drains have similar incidence of postoperative shoulder pain , drains should not be used with the intention of preventing shoulder pain Laparoscopy approach to cholecystectomy has shortened the recovery period , reducing discharge times from 1 to 3 days to same-day discharge . We hypothesize that the use of more than one modality to prevent postoperative pain may be more efficacious than single modality . Patients were r and omized to a treatment ( n = 24 ) or control ( n = 25 ) group and studied using a prospect i ve , double-blind design . Preoperatively , at 45 min before induction of anesthesia , the treatment group received an intramuscular ( IM ) bolus injection of meperidine 0.6 mg/kg and ketorolac 0.5 mg/kg . The control group received two bolus IM injections of placebo ( normal saline ) . Ten minutes before incision , local anesthesia ( treatment group ) or saline ( control group ) was infiltrated into the skin of each patient . Anesthetic management , postoperative pain , and nausea treatment were st and ardized . Pain and nausea assessment were done 1 h preoperatively , 0 , 0.5 , 1 , 2 , 3 , and 4 h postoperatively , at discharge , and 10 , 24 , and 48 h postoperatively . Patients were discharged by scoring criteria . Postoperatively , significantly more patients in the treatment group were without pain on arrival in the postanesthesia care unit ( PACU ) , 12/21 ( 57.1 % ) vs 1/24 ( 4.2 % ) in the control group ( P < 0.001 ) . Similarly , the severity of pain was sixfold less in the treatment group than in the control group . The incidence of nausea in the PACU was significantly less in the treatment group ; 4.7 % vs 29.5 % in the control group ( P < 0.05 ) . Patients from the treatment group satisfied Postanesthesia Discharge Score significantly earlier than those in the control group ( 281 + /- 12 min vs 375 + /- 19 min ; P < 005 ) . The concomitant use of local anesthetic and nonsteroidal antiinflammatory and opioid drugs proved to be highly effective in our patients , result ing in faster recovery and discharge . ( Anesth Analg 1996;82:44 - 51 BACKGROUND : The study was design ed to compare the effect of intraincisional vs intraperitoneal infiltration of levobupivacaine 0.25 % on post-operative pain in laparoscopic cholecystectomy . MATERIAL S AND METHODS : This r and omised controlled study was carried out on 189 patients who underwent laparoscopic cholecystectomy . Group 1 was the control group and did not receive either intraperitoneal or intraincisional levobupivacaine . Group 2 was assigned to receive local infiltration ( intraincisional ) of 20 ml solution of levobupivacaine 0.25 % , while Group 3 received 20 ml solution of levobupivacaine 0.25 % intraperitoneally . Post-operative pain was recorded for 24 hours post-operatively . RESULTS : Post-operative abdominal pain was significantly lower with intraincisional infiltration of levobupivacaine 0.25 % in group 2 . This difference was reported from 30 minutes till 24 hours post-operatively . Right shoulder pain showed significantly lower incidence in group 2 and group 3 compared to control group . Although statistically insignificant , shoulder pain was less in group 3 than group 2 . CONCLUSION : Intraincisional infiltration of levobupivacaine is more effective than intraperitoneal route in controlling post-operative abdominal pain . It decreases the need for rescue analgesia Background : We design ed a prospect i ve r and omized clinical trial to investigate whether intraperitoneal saline washout combined with a low-pressure pneumoperitoneum ( LPSW ) was superior to low-pressure pneumoperitoneum ( LP ) alone as a means of reducing post 
    Output:
    
IPI saline result ed in a significant reduction in SP severity compared with nothing .
IPI LA was associated with an overall significant reduction of SP severity compared with nothing .
Results regarding the effect IPI LA versus saline showed contradictory results in regards to both SP incidence and severity .
Conclusions Both IPI of saline and LA can be used to reduce SP severity after laparoscopic cholecystectomy .
It is not possible to conclude whether the incidence of SP can be reduced with saline or LA , due to contradictive results