***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objective We tested the hypothesis that local anesthetic administered before skin incision , an example of preemptive analgesia , reduces postoperative pain for women undergoing laparoscopy , as compared with postincisional local anesthetic or placebo . Methods Patients undergoing diagnostic laparoscopy were r and omized to one of three blinded treatment groups . Treatment group A patients received local infiltration of 0.5 % bupivacaine at the surgical site before incision and a saline placebo infiltration before incision closure . Treatment group B received the saline placebo before skin incision and bupivacaine after laparoscopy but before closure of the skin incisions . For treatment group C patients , saline was infiltrated as a placebo before and after laparoscopy . All patients underwent a st and ardized general anesthetic induction and maintenance . Postoperative pain was evaluated using the modified McGill Present Pain Intensity scale . Pain and supplementary analgesic use was compared among the three treatment groups . Results A total of 57 patients completed the study for analysis . Age , weight , height , race , indication , and operating time did not vary significantly between the three groups . By 24 hours after surgery , patients in treatment group A reported significantly lower pain scores ( McGill Present Pain Intensity Scale : 0.5 ± 0.9 ) than either treatment group B ( 1.6 ± 1.3 ) or C ( 1.3 ± 1.2 ) . Group A patients also could tolerate a significantly longer time delay to their first analgesic medication than patients who received postincisional bupivacaine or than control patients who received no bupivacaine . Conclusion The preemptive administration of bupivacaine before laparoscopy results in decreased postoperative pain and should allow a more rapid return to normal activities . The popular practice of infiltrating bupivacaine at time of incision closure does not offer any benefit in the control of pain after laparoscopy Following 189 laparoscopic sterilizations with the Falope-ring  , 33 cases of peroperative complications were registered . Laparotomy was required in one case . Sterilization undertaken in connection with termination of pregnancy was not associated with more peroperative complications than sterilization performed during an interval phase . In a r and omized trial comprising 100 women it was not possible to demonstrate that application of lidocaine to the tube reduced the incidence of immediate postoperative abdominal pain which occurred in 18 % of the women in the control group . A follow-up investigation of 91 women revealed change in bleeding pattern in 32 % and low abdominal pain de novo in 40 % . The frequencies of changes in bleeding pattern and of low abdominal pain were greater in women who had previously employed oral contraception than in women who had not done so . A question naire investigation comprising 169 women revealed that 38 % had developed one or more of the following symptoms : hot flushes , tendency to depression and irritability , and tachycardia . Alterations in libido were found in 26 % . 2 % regretted the sterilization . One pregnancy occurred in 172 sterilized women after an average observation period of 13 months Approximately 200 women of American Society of Anesthesiologists class I and II physical status electing outpatient laparoscopic tubal sterilization with Yoon rings  were involved in a double-blind study to evaluate postoperative pain relief after intraoperative suprapubic infiltration of the fallopian mesosalpinx . The postoperative pain levels were lower after bilateral infiltration of 0.5 % bupivacaine beneath the site of ring application . Postoperative , suprapubic infiltration provided safe , prolonged and effective pain relief , allowed prompt ambulation and early discharge , and reduced the need for narcotic analgesics and postoperative analgesia Narcotic requirements in 51 day-surgery patients following laparoscopic tubal occlusion were significantly reduced ( P less than .01 ) by the use of 1 % etidocaine 5 mL , dropped on each fallopian tube from uterus to fimbrias before tubal b and ing when compared with a control group of 51 day-surgery patients who had no topical anesthetic agent .  All patients received general anesthesia . Although there was no significant difference in nausea rate , the incidence of vomiting was decreased . Eight of 51 patients ( 16 % ) having topical etidocaine and 19 of 51 ( 37 % ) who had no etidocaine  vomited during the postoperative period . The frequency of overnight stay was significantly reduced in the topical etidocaine group of patients ( P less than or equal to .01 ) Objective To investigate the efficacy of applying 10 ml bupivacaine 0.5%versus normal saline to the fallopian tubes under direct vision during day case laparoscopic sterilisation under general anaesthesia After laparoscopic cholecystectomy , CO2 remains within the peritoneal cavity , commonly causing pain . This prospect i ve r and omized study was performed to determine the efficacy of intraperitoneal normal saline and bupivacaine infusion on  postoperative pain after laparoscopic cholecystectomy . Three hundred patients were r and omly assigned to one of six groups of 50 patients each . Group A patients served as controls . In group B patients , normal saline was infused under the right hemidiaphragm and suctioned after the pneumoperitoneum was deflated . After suction , a subhepatic closed drain was left for 24 h. In group C patients , bupivacaine 1.5 mg/kg in solution 2.5 mg/ml , minus 15 ml of this solution , which was infiltrated in the trocar wounds , was infused under the right hemidiaphragm at the end of the cholecystectomy . In group D patients , bupivacaine was given as in group C , but a subhepatic drain was left for 24 h. In group E patients , normal saline was used as in group B plus bupivacaine as in group C. Group F patients were treated as in group E , but a subhepatic drain was left for 24 h. In all groups , 15 ml of a 2.5 mg/ml bupivacaine solution was infiltrated in the trocar wounds . Postoperatively , analgesic medication usage , nausea , vomiting , and pain scores were recorded at 2 , 6 , 12 , 24 , 36 , 48 , and 72 h. Postoperative pain was reduced significantly in the patients of the treatment groups vs. the controls . Between treatment groups , patients in groups B , E , and F had the best results , while those in groups C and D had significantly greater pain than those in groups B , E , and F. It is concluded that postoperative pain after laparoscopic cholecystectomy can be significantly reduced by intraperitoneal normal saline infusion subdiaphragmatically and after its postdeflation suction , bupivacaine infusion in the same area , or without bupivacaine in case a subhepatic drainage has been needed This r and omized double-blind placebo-controlled study was design ed to evaluate the effects on  postoperative pain of the local anesthetic , 0.5 % bupivacaine with epinephrine , sprayed hepatodiaphragmatically under the surgeon 's direct view during laparoscopic cholecystectomy . Metabolic endocrine responses to surgery ( glucose and cortisol ) and nonsteroidal anti-inflammatory drug requirements were investigated , as well as the presence of nausea , vomiting , and sweating . Local anesthetics or placebo solutions were given as follows . Immediately following the creation of a pneumoperitoneum , surgeons sprayed the first 20 mL of solution ( S1 ) , and an additional 20 mL of solution ( S2 ) was sprayed at the end of the operation . Patients were classified into three groups ( 14 patients per group ) . Group A received 20 mL of saline during both S1 and S2 , group B received 20 mL of saline during S1 and 20 mL of bupivacaine during S2 , and group C received 20 mL of bupivacaine during both S1 and S2 . The degree of postoperative pain was assessed using the visual analogue scale ( VAS ) and the verbal rating scale ( VRS ) on arrival in the recovery room and subsequently at time intervals of 4 h , 8 h , 12 h , and 24 h. The results of this study indicate a significant decrease of postoperative pain in patients treated with local anesthetic .  VAS and VRS pain scores , as well as respiratory rate and analgesic requirements , were significantly lower in group C. The postoperative plasma cortisol level in group C was significantly lower than in groups A and We investigated , in a double-blind study , the effects of intraperitoneal local anesthetics during laparoscopic cholecystectomy . In Part A of the study 30 patients received 50 mL saline 0.9 % ( A 0 ) , bupivacaine 0.125 % ( A 125 ) , or bupivacaine 0.25 % ( A 25 ) intraperitoneally at the end of surgery .  Mean maximum plasma concentrations of bupivacaine reached 0.48 mg/L ( range 0.15 - 0.90 mg/L ) in Group A 125 and 1.0 mg/L ( 0.35 - 2.10 mg/L ) in Group A 25 within 15 min ( range , 5 - 30 min ) . There was no significant difference in pain scores or opioid consumption ( patient-controlled analgesia with piritramid ) : 24 , 28 , and 13 mg/24 h among the study groups , respectively ( not significant ) . Postoperative respiratory function deteriorated in comparison to preoperative values in all study groups , but the forced vital capacity was significantly more impaired in Group A.25 . In Part B , 24 patients received placebo ( B 0 ) or bupivacaine 0.25 % ( B 25 ) . Postoperative hypoxemic periods ( oxygen saturation < 92 % ) were significantly more frequent in Group B 25 . Considering the question able benefits and the potential risks , we would not recommend the application of intraperitoneal bupivacaine during laparoscopic cholecystectomy . ( Anesth Analg 1995;81:967 - 72 OBJECTIVE To evaluate the efficacy of intraperitoneal subdiaphragmatic instillation of lidocaine and trocar site infiltration of bupivacaine to minimize postoperative pain after diagnostic microlaparoscopy performed under local anesthesia with conscious sedation . DESIGN Prospect i ve r and omized study . SETTING Day-surgery unit of Endogyn Service , Naples , and Department of Gynecologic and Pediatric Sciences , Reggio Calabria University , Catanzaro , Italy . PATIENT(S ) Sixty-one women with infertility . INTERVENTION(S ) All patients received local anesthesia and conscious sedation before surgery . After the microlaparoscopy , the treatment group was given 40 mL of intraperitoneal subdiaphragmatic 0.5 % lidocaine and 5 mL of 0.5 % bupivacaine that was infiltrated into the trocar insertion sites . The control group received no treatment . When necessary , ketoprofene or ketorolac were administered IM after surgery . MAIN OUTCOME MEASURE(S ) Postoperative pain was evaluated with the use of a visual analog scale with scores ranging from 1 - 10 immediately after surgery and over the next 48 hours . The rate at which patients were discharged from the hospital 2 hours after surgery also was recorded . RESULT ( S ) The treatment group had significantly lower pain scores both immediately after surgery and 1 , 3 , and 6 hours afterward . The need for postoperative analgesics also was significantly lower in the treatment group . The rate at which patients were discharged 2 hours after surgery was significantly higher in the treatment group . CONCLUSION ( S ) Postoperative intraperitoneal lidocaine administration and bupivacaine infiltration of the trocar sites is beneficial for patients undergoing microlaparoscopy . The effect of these drugs is temporary , but they can significantly decrease postoperative pain for approximately 6 hours and reduce the need for additional analgesics . Most important , the rate at which patients can be discharged from the hospital only 2 hours after surgery is increased significantly After laparoscopic cholecystectomy , residual gas is inevitably retained in the peritoneal cavity . An active attempt is not always made to remove it . Using a double-blind prospect i ve protocol in 40 healthy patients , we evaluated the effect of residual pneumoperitoneum on  post-laparoscopic cholecystectomy pain intensity .  On completion of surgery , prior to removal of the surgical instruments , the patients were r and omly divided into two groups : in the active aspiration ( AA ) group an active attempt was made to remove as much gas as possible from the peritoneal cavity , while in the nonactive aspiration ( NAA ) group no such effort was made . Postoperative pain was assessed hourly over a 4-h period with a visual analog scale ( VAS ) and a patient-controlled analgesia ( PCA ) device . During the first postoperative hour , the NAA patients made significantly ( P < 0.05 ) more dem and s ( mean ± SD ) for morphine than those in the AA group ( 31.3 ± 26.2 VS 15.3 ± 15.7 ) and also received a borderline significantly ( P = 0.056 ) larger dose ( mean ± SD ) of PCA morphine ( 3.9 ± 1.9 mg VS 2. 
    Output:
    
We conclude that there was evidence for a statistically significant but clinical ly question able , important effect of intraperitoneal LA for postoperative pain control .
There was evidence for a significant but short-lasting effect of mesosalpinx/fallopian tube block after sterilization , but there was a lack of evidence for any important effect of port-site infiltration .
This systematic review confirms intraperitoneal and mesosalpinx local anesthetic block , not port-site infiltration , to have some impact on postoperative pain after laparoscopy