***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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    Input: Background : Ultrasound-guided transversus abdominis plane ( TAP ) block has recently come up as a modality to take care of postoperative pain . It can somewhat avoid the use of intravenous opioid analgesics and hence to avoid its complications . We have performed a prospect i ve , double-blinded , r and omized study to assess the analgesic effect of adding dexmedetomidine to local ropivacaine on TAP block for patients undergoing lower abdominal surgeries . Aim : The aim is to assess whether addition of dexmedetomidine to ropivacaine may bring some improvements to the analgesic efficacy of TAP blocks in patients undergoing lower abdominal surgeries . Material s and Methods : The study was conducted on forty patients undergoing lower abdominal surgeries under general anesthesia . The patients were divided into two groups : one receiving plain ropivacaine ( Group 1 ) and other receiving ropivacaine with dexmedetomidine ( Group 2 ) during TAP block . The patients in the two groups were compared for age , sex , body mass index , incidence of postoperative nausea , and vomiting and pain as measured on visual analog scale ( VAS ) . Results : There was significantly lower pain score on VAS at 1 , 3 , 6 , 12 , and 18 h in Group 2 than in Group 1 . Conclusion : The addition of dexmedetomidine to ropivacaine during TAP block improves analgesic effect of TAP block and prolongs the duration of analgesia as well BACKGROUND : Superior early pain control has been suggested with transversus abdominis plane blocks , but evidence -based recommendations for transversus abdominis plane blocks and their effects on patient outcomes are lacking . OBJECTIVE : The aim of this study was to determine whether transversus abdominis plane blocks improve early postoperative outcomes in patients undergoing laparoscopic colorectal resection already on an optimized enhanced recovery pathway . DESIGN : This study is based on a prospect i ve , r and omized , double-blind controlled trial . SETTING S : The trial was conducted at a tertiary referral center . PATIENTS : Patients undergoing elective laparoscopic colorectal resection were selected . INTERVENTIONS ( S ) : Patients were r and omly assigned to receive either a transversus abdominis plane block or a placebo placed intraoperatively under laparoscopic guidance . All followed a st and ardized enhanced recovery pathway . Patient demographics , perioperative procedures , and postoperative outcomes were collected . MAIN OUTCOME MEASURES : Postoperative pain and nausea/vomiting scores in the postanesthesia care unit and department , opioid use , length of stay , and 30-day readmission rates were measured . RESULTS : The trial r and omly assigned 41 patients to the transversus abdominis plane block group and 38 patients to the control group .  Demographic , clinical , and procedural data were not significantly different . In the postanesthesia care unit , the transversus abdominis plane block group had significantly lower pain scores ( p < 0.01 ) and used fewer opioids ( p < 0.01 ) than the control group ; postoperative nausea/vomiting scores were comparable ( p = 0.99 ) . The transversus abdominis plane group had significantly lower pain scores on postoperative day 1 ( p = 0.04 ) and throughout the study period ( p < 0.01 ) . There was no significant difference between groups in postoperative opioid use ( p = 0.65 ) or nausea/vomiting ( p = 0.79 ) . The length of stay ( median , 2 days experimental , 3 days control ; p = 0.50 ) and readmission rate ( 7 % experimental , 5 % control , p = 0.99 ) was similar across cohorts . LIMITATIONS : This study was conducted a single center . CONCLUSIONS : Transversus abdominis plane blocks improved immediate short-term opioid use and pain outcomes . Pain improvement was durable throughout the hospital stay . However , the blocks did not translate into less overall narcotic use , shorter length of stay , or lower readmission rates Background The transversus abdominis plane block is recently described peripheral block to providing analgesia to the anterior abdominal wall . The goal of this study is to evaluate the analgesic efficacy of the ultrasound-guided transversus abdominis plane block ( US-TAP block ) in patients undergoing gynecologic surgery via a transverse lower abdominal skin incision . Methods Thirty-two patients undergoing gynecologic surgery were r and omized to undergo  st and ard care such as PCA , or to receive additional US-TAP block with st and ard care .  After general anesthesia induction , a bilateral US-TAP block was performed using 0.375 % ropivacaine 20 ml on each side .  Postoperative dem and of rescue analgesics in PACU and ward were recorded . Each patient was assessed postoperatively by a blinded investigator in the postanesthesia care unit ( PACU ) and at 2 , 6 , 10 , 24 , 48 hr postoperatively to investigate pain , drowsiness , nausea and itch . Results The US-TAP block reduced pain intensity compared to st and ard care in the PACU ( 5.2 ± 3.1 vs 8.4 ± 1.3 ) and at 2 , 24 postoperative hours ( 3.0 ± 2.4 vs 5.2 ± 2.4 , 0.9 ± 1.5 vs 2.2 ± 1.9 ) . Fentanyl requirements in PACU was reduced ( 20.3 ± 20.9 vs 62.5 ± 35.4 µg , P < 0.05 ) . In ward , pethidine requirements was reduced ( 21.9 ± 28.7 vs 56.3 ± 34.8 mg , P < 0.05 ) . Conclusions The US-TAP block with st and ard care provide more effective analgesia after gynecologic surgery via a transverse lower abdominal skin incision Background Although enhanced recovery pathways ( ERPs ) may permit early recovery and discharge after laparoscopic colorectal surgery ( LC ) , most publications report that the mean hospital stay is 4 and 6 days . This study evaluates the addition of a transversus abdominis plane ( TAP ) block to the st and ard ERP . Methods In this study , 35 consecutive elective patients received a TAP block at the end of LC . The patients were matched by operation , diagnosis , age , gender , and body mass index ( BMI ) with 35 recent cases and followed in a prospect i ve institutional review board (IRB)-approved data base . All the patients were managed with a st and ardized ERP . The surgeon placed TAP blocks under laparoscopic guidance that infiltrated 15 ml of 0.5 % Marcaine on both sides of the abdomen . Results The cases included 8 low pelvic anastomoses , 4 proctectomies with or without an ileal pouch anal anastomosis , 5 sigmoid/left colectomies , 13 ileocolic/right colectomies , 1 total colectomy , and 5 others . The mean age was 59 years for the TAP group and 64.1 years for the control group ( p = 0.21 ) . The mean hospital stay was 2 days for the TAP patients and 3 days for the control patients ( p = 0.000013 ) . Of the 35 TAP patients , 13 went home on postoperative day ( POD ) 1 ( 37 % ) , 12 on POD 2 ( 34 % ) , 8 on POD 3 ( 23 % ) , and the remainder on POD 4 . Of the 35 control patients , 1 went home on POD 1 ( 3 % ) , 10 on POD 2 ( 29 % ) , 10 on POD 3 ( 29 % ) , 11 on POD 4 ( 31 % ) , and the remainder on POD 5 to 8 . The TAP patients required fewer narcotics postoperatively than the control patients ( respective mean morphine equivalents , 31.08 vs. 85.41 ; p = 0.01 ) . Discussion A bilateral TAP block significantly improved the results of an established ERP for patients undergoing LC . Surgeon-administered TAP blocks may be an economical and efficient method for improving the results of LC INTRODUCTION Opioid sparing in postoperative pain management appears key in colorectal enhanced recovery . Transversus abdominis plane ( TAP ) blocks offer such an effect . This study aim ed to quantify this effect on pain , opioid use and recovery of bowel function after laparoscopic high anterior resection . METHODS This was a retrospective analysis of prospect i ve data on 68 patients . Patients received an epidural ( n=24 ) , intravenous morphine patient controlled analgesia ( PCA , n=22 ) or TAP blocks plus PCA ( n=22 ) determined by anaesthetist preference . Outcome measures were numerical pain scores ( 0 - 3 ) , cumulative intravenous morphine dose and time to recovery of bowel function ( passage of flatus or stool ) . RESULTS There were no differences in patient characteristics , complications or extraction site . The TAP block group had lower pain scores ( 0.7 vs 1.36 , p<0.001 ) and morphine requirements ( 8 mg vs 15 mg , p=0.01 ) than the group receiving PCA alone at 12 hours and 24 hours . Earlier passage of flatus ( 2.0 vs 2.7 vs 3.4 days , p=0.002 ) , stool ( 3.1 vs 4.1 vs 5.5 days , p=0.04 ) and earlier discharge ( 4 vs 5 vs 6 days , p=0.02 ) were also seen . CONCLUSIONS Use of TAP blocks was found to reduce pain and morphine use compared with PCA , expedite recovery of bowel function compared with PCA and epidural , and expedite hospital discharge compared with epidural Background The increasing use of laparoscopic techniques for colorectal resections means that the issue of postoperative analgesia needs to be reassessed . This nonr and omized comparative study aim ed to assess the efficacy of the transversus abdominis plane ( TAP ) block in laparoscopic colorectal resections . Methods Prospect ively collected data from consecutive patients undergoing laparoscopic colorectal resections were used . Analgesia usage and outcome data for patients who had a TAP block and a postoperative morphine patient-controlled analgesia pump ( PCA ) were compared with those for patients who had a PCA alone . Results Data for 74 patients were used in the final analysis ( 40 TAP/PCA and 34 PCA alone ) . There was a significant reduction in overall intravenous opiate use in the TAP/PCA group ( 31.3 vs. 51.8 mg ; P = 0.03 ) . The TAP/PCA group showed a slight trend toward a shorter hospital stay ( 3 vs. 4 days ; P = 0.17 ) but no difference in postoperative complications or any other outcome measure . There was no procedure-related morbidity relating to the use of TAP blocks . Conclusions It appears that TAP blocks reduce postoperative analgesia use of patients undergoing laparoscopic colorectal resections within an enhanced recovery program , and this may have an impact on their postoperative hospital length of stay Background Although h and -assisted laparoscopic surgery ( HALS ) offers patients smaller surgical incisions , they still experience pain . Currently , there is no consensus on the optimal analgesic package for patients undergoing HALS .  The aim of this prospect i ve , r and omized , double-blinded , placebo-controlled clinical trial was to evaluate the effect of transversus abdominis plane ( TAP ) block on postoperative pain control ( pain score and analgesic use ) and other outcomes in colon cancer patients undergoing h and -assisted laparoscopic left hemicolectomy . Methods Sixty-four patients with colon cancer scheduled for an elective colon resection were enrolled in this study . Patients were r and omized into two groups to receive either TAP block using 20 mL of 0.375 % ropivacaine ( TAP block group : 32 patients ) or 20 mL of 0.9 % normal saline infusion ( placebo group : 32 patients ) . Anaesthetic and surgical techniques were st and ardized . Twenty-four-hour postoperative analgesia was maintained by continuous infusion of 0.1–0.9 µg/kg/h fentanyl and intravenous injection of ketorolac . The primary outcome of the study was postoperative pain control ( pain score and analgesic use ) . Pain was assessed using numeric rating scale at 2 , 4 , 8 , 12 , and 24 h after surgery at rest and during movement . Secondary outcomes included the time to resumption of intestinal function and the length of hospital stay . The data of the two groups were compared using Mann – Whitney U test . All statistical tests were two-tailed at a significance level of 0.05 . Results The patients ’ mean age was 60.50 ± 6.77 years , and 68.75 % of patients were males . The mean body mass index was 26.23 ± 4.83 kg/m2 . The TAP block group had lower pain scores after surgery at 2 , 4 , and 12 h at rest ( p < 0.05 ) , at 2 and 4 h during movement ( p < 0.01 ) and used less fentanyl and ketorolac than the placebo group ( p < 0.01 ) . The mean time to resumption of intestinal function 
    Output:
    
Conclusions The TAP block using a short-acting anesthetic had a significant effect on the postoperative pain outcome in the early ( 0–2 h ) and late ( 24 h ) period at movement .
However , it did not have a significant effect on the postoperative pain outcome in the early ( 0–2 h ) and late ( 24 h ) periods at rest after laparoscopic surgery