***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 : Clonidine has been shown to reduce perioperative circulatory instability . This postoperative analgesic effect of clonidine was also known in previous studies . The aim of the study was to investigate the clinical efficiency of oral clonidine premedication in anesthesia and analgesia in patients undergoing laparoscopic cholecystectomy Postoperative pain is the most common complaint after laparoscopic cholecystectomy . This study was carried out to evaluate whether preoperative administration of intramuscular dezocine can provide postoperative analgesia and reduce postoperative opioid consumption in patients undergoing laparoscopic cholecystectomy . Patients ( ASA I or II ) scheduled for laparoscopic cholecystectomy were r and omly assigned into intramuscular dezocine group ( group 1 ) or intramuscular normal saline group ( group 2 ) . Dezocine and equal volume normal saline were administered intramuscularly 10 min before the induction of anesthesia . After operation , the severity of postoperative pain , postoperative fentanyl requirement , incidence and severity of side-effects were assessed . Postoperative pain and postoperative patient-controlled fentanyl consumption were reduced significantly in group 1 compared with group 2 . The incidence and severity of side effects were similar between the two groups . Preoperative single-dose administration of intramuscular dezocine 0.1 mg/kg was effective in reducing postoperative pain and postoperative patient-controlled fentanyl requirement in patients undergoing laparoscopic cholecystectomy STUDY OBJECTIVE To compare the effects of preoperative intravenous ( IV ) tramadol and preoperative tramadol infiltration of trocar sites on postoperative pain and postoperative nausea and vomiting ( PONV ) after laparoscopic cholecystectomy . DESIGN Prospect i ve , r and omized study . SETTING Operating room , recovery room , and surgical ward . PATIENTS 70 ASA physical status 1 and 2 patients , aged 20 - 70 years , scheduled for elective laparoscopic cholecystectomy . INTERVENTIONS In Group I , patients received IV 2.0 mg/kg of tramadol ; in Group II , trocar insertion points were infiltrated with 2.0 mg/kg of tramadol in 20 mL of 0.9 % NaCl . MEASUREMENTS Pain scores , sedation scores , postoperative analgesic requirement , and PONV were recorded at 0 and 30 minutes and one , three , 6 , 12 , and 24 hours . At 30 minutes and one hour , pain localization ( incisional or diffuse abdominal ) was also recorded . MAIN RESULTS Visual analog scale scores at 30 minutes were significantly lower in Group II [ 3 ( 0 - 7 ) ] than Group I [ 6 ( 3 - 8 ) ] ( P < 0.001 ) . In Group I , 91.4 % of patients received sodium diclofenac , while 68.6 % of Group II patients received sodium diclofenac ( P = 0.002 ) . The time to first analgesic requirement was significantly lower in Group II ( P = 0.004 ) . At the 30-minute measurement time , a significant difference was recorded between the groups in incisional pain ( P < 0.001 ) . There was also a significant difference between groups in the frequency of PONV . CONCLUSIONS Trocar site infiltration of tramadol improves early postoperative pain and decreases PONV AIMS To investigate the incidence , risk factors and natural history of gallstone disease , a r and om sample of females belonging to a rural population was enrolled in a ten-year longitudinal study . METHODS The study has been performed in a small town on the hills south of Rome . In 1985 , a r and om sample of 426 females , aged 20 - 69 years , was screened by real-time ultrasonography for gallstones and previous cholecystectomy .  Screening methods included anthropometry , collection of a blood sample and a question naire on the occurrence of abdominal symptoms . During 1995 , all these subjects were invited for a 10-year follow-up examination . RESULTS The overall 10-year incidence of gallstone disease was 6.3 % ( 5.5 % of new gallstones and 0.8 % of cholecystectomies ) . Only 23.1 % of the women with gallstones were aware of their condition . More than three quarters ( 76.9 % ) had not suffered biliary pain . Univariate and multivariate analyses demonstrated a positive independent association of new gallstone disease with body mass index and parity . Out of the initially asymptomatic gallstone women , 15.4 % experienced at least one episode of biliary pain , 23.1 % were su bmi tted to elective cholecystectomy and 61.5 % remained asymptomatic . CONCLUSIONS The study demonstrates a high incidence of gallstone disease in women belonging to a rural free-living population in Italy and suggests body mass index and parity as possible true risk factors . Moreover , it confirms that a remarkable proportion of asymptomatic patients become symptomatic and eventually undergo cholecystectomy BACKGROUND Since the time to peak analgesic effect of intravenous morphine can be longer than 40 - 60 min in volunteers , the goal of this study was to evaluate the effect of the timing of intraoperative morphine administration on  early postoperative pain .  METHODS A total of 120 adult patients undergoing laparoscopic cholecystectomy were studied .  Anaesthesia was induced with remifentanil and etomi date and maintained with remifentanil and sevoflurane/nitrous oxide . Morphine 150 micrograms kg-1 was given r and omly at three different times during surgery , and a fourth group received placebo .  Times to eyes opening and extubation were measured , and pain was evaluated in the post-anaesthesia care unit ( PACU ) using a visual analogue scale ( VAS ) . Morphine 2 - 3 mg was given when the VAS score was > or = 50 mm . The four groups were , according to the time elapsed from morphine administration to the end of surgery , group 1 ( n = 30 ) : placebo ; group 2 ( n = 33 ) : < 20 min ; group 3 ( n = 30 ) : 20 - 40 min ; group 4 ( n = 27 ) : > 40 min . RESULTS Recovery from anaesthesia and pain scores were similar in all groups . However , mean ( SD ) morphine consumption was 5.7 ( 4.7 ) mg in group 1 , 4.4 ( 4.2 ) mg in group 2 , 4.7 ( 4.7 ) mg in group 3 , and 2.2 ( 4.0 ) mg in group 4 ( P < 0.05 , group 1 vs 4 ) .  Morphine  was required in only 38 % of patients in group 4 compared with 83 % , 67 % and 69 % in groups 1 , 2 , and 3 , respectively ( P < 0.01 , group 1 vs 4 ) . CONCLUSIONS The timing of intraoperative morphine administration did not affect the early recovery from anaesthesia . However , the reduction in the number of patients requiring morphine  in the PACU when morphine had been given more than 40 min before the end of surgery supports this practice , rather than administration closer to the end of surgery Laparoscopic cholecystectomy is widely used and may be performed as an ambulatory procedure . We undertook a r and omized comparison of the benefits of intraperitoneal pethidine compared with intramuscular pethidine for postoperative analgesia following laparoscopic cholecystectomy . A series of 100 consecutive American Society of Anesthesiologists ( ASA ) I or II patients were r and omly assigned to intramuscular pethidine ( 54 patients ) or intraperitoneal pethidine ( 46 patients ) . Each was combined with intraperitoneal bupivacaine . The primary end-points were the pain and nausea scores at intervals after operation . All recruited patients completed the study . Pain scores at rest and upon movement were significantly lower in the group receiving the intraperitoneal pethidine at each of the time periods examined ( pain at rest at 4 hours : 1.6±0.8 vs. 2.4±0.9 cm ; p<0.001 ; pain upon movement at 4 hours : 2.1±0.9 vs. 3.1±1.2 cm ; p<0.001 ) . The total dose of pethidine administered via patient-controlled analgesia ( PCA ) during the first 24 hours after surgery was also significantly lower in this group ( total dose 50.9±3.9 vs. 55.9±4.4 mg ; p<0.001 ) . There were no significant differences in the respiratory rate at any of the time periods . Intraperitoneal pethidine  analgesia was superior to an equivalent dose of intramuscular pethidine for the relief of postoperative pain in patients undergoing laparoscopic cholecystectomy . This was achieved at the expense of increased nausea but no significant increase in vomiting . The accessibility of this route of analgesia administration has implication s for patients undergoing laparoscopic procedures , particularly with the recent trend toward increased use of ambulatory techniques . RésuméLa cholécystectomie laparoscopique est réalisée dans le monde entier et peut être réalisée en ambulatoire . Nous avons comparé par une étude r and omisée les bénéfices de la pethidine en intraperitoneal comparée à la pethidine en intramusculaire pour l’analgésie postcholecystectomic laparoscopique . Cent patients consécutifs , ASA I ou II , ont été r and omisés pour recevoir soit de la pethidine en intra-musculaire ( 54 patients ) ou en intrapéritonéale ( 46 patients ) . De la bupivacaïne a été administrée en intrapéritonéale chez tous les patients . Les critères de jugement principaux et secondaires ont été les scores de la douleur et de la nausée à des intervalles successifs post-opératoires . Tous les patients inclus ont complété l’étude . La douleur au repos et lors des mouvements a été significativement moindre dans le groupe recevant de la pethidine en intrapéritonéale à chaque intervalle étudié [ douleur au repos à 4 heures : 1.6 ( 0.8 ) cm vs. 2.4 ( 0.9 ) cm ; p=0.001 ; douleur lors des mouvements à 4 heures : 2.1 ( 0.9 ) cm vs. 3.1 ( 1.2 ) cm ; p=0.001 ] . La dose totale de pethidine administrée via la PCA pendant les 24 premières heures après chirurgie a également été plus basse dans ce groupe [ dose totale 50.9 ( 3.9 ) mg vs. 55.9 ( 4.4 ) mg ; p=0.001 ] . Il n’y avait aucune différence statistiquement significative en ce qui concernait la fréquence respiratoire quel que soit le moment de l’étude . La pethidine en intrapéritonéale est supérieure à la pethidine en intramusculaire pour l’analgésie de la douleur post-cholécystectomie laparoscopique . Cette amélioration a été accomplie au prix de plus de nausées mais sans augmentation significative des vomissements . L’utilisation de cette route d’administration a des implication s importantes chez le patient opéré sous laparoscopic , en particulier , vu la tendance actuelle à élargir les indications de la chirurgie ambulatoire . ResumenLa colecistectomía laparoscópica es el procedimiento más empleado en cirugía ambulatoria . Efectuamos un estudio comparative aleatorio sobre los efectos , de la petidina intraperitoneal vs intramuscular , en la analgesia postcolecistectomía laparoscópica .  100 pacientes ASA I o II fueron aleatoriamente distribuidos en 2 grupos : petidina intramuscular ( n=54 ) y petidina intraperitoneal ( n=46 ) ; a este último grupo se le asoció bupivacaina intraperitoneal . Se investigaron el dolor y las nauseas durante el postoperatorio . Todos los pacientes completaron el estudio . El dolor postoperatorio tanto en reposo como con la movilización fue significativamente menor en el grupo de petidina intraperitoneal [ dolor en reposo a las 4 horas 1.6 ( 0.8 ) cm vs 2.4 ( 0.9 ) cm ; p<0.001 ; dolor a la movilización a las 4 horas 2.1 ( 0.9 ) cm vs 3.1 ( 1.2 ) cm ; p<0.001 ] . Además , en este grupo la dosis total de petidina  administrada en las primeras 24 horas del periodo postoperatorio fue menor [ dosis total 50.9 ( 3.9 ) mg vs 55.9 ( 4.4 ) mg , p<0.001 ] . No se observaron diferencias significativas en la frecuencia respiratoria a lo largo del periodo postoperatorio . La analgesia proporcionada por la administración intraperitoneal de petidina es superior a la obtenida por inyección intramuscular , aunque se produzcan más nauseas pero sin que se incremente la frecuencia de vómitos . Dada la accesibilidad de esta 
    Output:
    
The pharmacological interventions in all the included trials were aim ed at preventing pain after laparoscopic cholecystectomy .
There is evidence of very low quality that different pharmacological agents including non-steroidal anti-inflammatory drugs , opioid analgesics , and anticonvulsant analgesics reduce pain scores in people at low anaesthetic risk undergoing elective laparoscopic cholecystectomy .