***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: STUDY OBJECTIVE To estimate the difference in pain associated with the wearing or removal of suction or non-suction drains after gynecologic laparoscopic surgery . DESIGN A r and omized controlled trial from August 2006 through October 2007 ( Canadian Task Force Classification I ) . SETTING Royal Hospital for Women , Department of Endo-Gynaecology and School of Women 's and Children 's Health University of New South Wales . PATIENTS A total of 168 women undergoing gynecologic laparoscopy requiring postoperative drainage . INTERVENTIONS Patients were r and omized to receive either a suction or non-suction drain after surgery . MEASUREMENTS AND MAIN RESULTS Pain was assessed before , during , and after drain removal with a 4-point verbal descriptor scale and 10-cm visual analogue scale . Visual analogue scale and verbal descriptor scale scores for suction versus non-suction groups were 3 versus 3 ( p=.654 ) and 1 versus 1 ( p=.686 ) before removal , 9 versus 7 ( p=.016 ) and 3 versus 2 ( p=.029 ) during removal , and 7 versus 5 ( p=.058 ) and 2 versus 2 ( p=.122 ) after removal . CONCLUSION There is no significant difference in patient discomfort while wearing or after removal of suction or non-suction drains . However , suction drains are more painful to have removed STUDY OBJECTIVE To assess the benefits of the combination of a gas drain and the instillation of local anesthetic on the incidence of pain after operative gynecologic laparoscopy . DESIGN R and omized control trial ( Canadian Task Force classification I ) . SETTING Tertiary referral center . PATIENTS One hundred twenty-eight patients undergoing operative gynecologic laparoscopy procedures lasting less than 105 minutes . INTERVENTIONS Postoperatively , one group received a blocked drain and saline placed intraperitoneally ; a second group was given a blocked drain and ropivacaine ; a third group received a patent drain and saline ; and a fourth was given a patent drain and ropivacaine . MEASUREMENTS AND MAIN RESULTS Visual analogue pain scores ( VAS ) were measured at 1 , 2 , 4 , and 12 hours and day 1 to day 7 . Also measured was opioid consumption at 4 hours , nausea , and activity scores . We found a statistically significant improvement in pain scores at 2 and 4 hours in the group allocated to receive a patent drain and ropivacaine . CONCLUSION We recommend the use of a gas drain and ropivacaine to reduce postoperative pain BACKGROUND Postoperative shoulder pain remains a significant problem after laparoscopy . Pneumoperitoneum with insufflation of carbon dioxide ( CO2 ) is thought to be the most important cause . Reduction of pneumoperitoneum pressure may , however , compromise surgical visualisation . Recent studies indicate that the use of deep neuromuscular blockade ( NMB ) improves surgical conditions during a low-pressure pneumoperitoneum ( 8 mmHg ) . OBJECTIVE The aim of this study was to investigate whether low-pressure pneumoperitoneum ( 8 mmHg ) and deep NMB ( posttetanic count 0 to 1 ) compared with st and ard-pressure pneumoperitoneum ( 12 mmHg ) and moderate NMB ( single bolus of rocuronium 0.3 mg kg−1 with spontaneous recovery ) would reduce the incidence of shoulder pain and improve recovery after laparoscopic hysterectomy . DESIGN A r and omised , controlled , double-blinded study . SETTING Private hospital in Denmark . PARTICIPANTS Ninety-nine patients . INTERVENTIONS R and omisation to either deep NMB and 8 mmHg pneumoperitoneum ( Group 8-Deep ) or moderate NMB and 12 mmHg pneumoperitoneum ( Group 12-Mod ) . Pain was assessed on a visual analogue scale ( VAS ) for 14 postoperative days . MAIN OUTCOME MEASURES The primary endpoint was the incidence of shoulder pain during 14 postoperative days . Secondary endpoints included area under curve VAS scores for shoulder , abdominal , incisional and overall pain during 4 and 14 postoperative days ; opioid consumption ; incidence of nausea and vomiting ; antiemetic consumption ; time to recovery of activities of daily living ; length of hospital stay ; and duration of surgery . RESULTS Shoulder pain occurred in 14 of 49 patients ( 28.6 % ) in Group 8-Deep compared with 30 of 50 ( 60 % ) patients in Group 12-Mod . Absolute risk reduction was 0.31 ( 95 % confidence interval 0.12 to 0.48 ; P = 0.002 ) . There were no differences in any secondary endpoints including area under the curve for VAS scores . CONCLUSION Deep NMB and low-pressure pneumoperitoneum ( 8 mmHg ) reduced the incidence of shoulder pain after laparoscopic hysterectomy in comparison to moderate NMB and st and ard-pressure pneumoperitoneum ( 12 mmHg ) . TRIAL REGISTRATION Clinical trials.gov identifier : NCT01722097 Background and Objectives : Shoulder pain is one of the early postlaparoscopic symptoms related to CO2 used for pneumoperitoneum and remaining in the abdomen . The present study was conducted to vali date the hypothesis that complete evacuation of the residual CO2 would prevent postlaparoscopic shoulder pain . Methods : Forty consecutive patients , the c and i date s for gynecologic laparoscopic surgery , were r and omly enrolled into one of the following 2 groups . Nineteen patients entered Group I where the residual CO2 was evacuated by abdominal oppression and served as the study control group . The remaining 21 patients entered Group II , where the residual CO2 was evacuated by pumping warm saline into the abdomen until it spilled out of the open ports . Nurses , blind to the patient 's grouping , recorded shoulder pain VAS scores twice daily . Results : VAS scores in Group I started to increase at Day 1AM , reached a peak at Day 1PM , and decreased gradually thereafter . VAS scores in Group II stayed low throughout the investigation period . The difference was highly significant ( P<0.001 ) . Conclusions : Abdominal filling with saline at the end of laparoscopic surgery effectively evacuates residual CO2 thus preventing postlaparoscopic shoulder pain OBJECTIVE To assess the efficacy of multimodal intraoperative analgesia in reducing postoperative pain and /or opioid requirements in women undergoing laparoscopic excision of endometriosis . DESIGN Prospect i ve , r and omized , double-blind , placebo-controlled trial . SETTING Endogynecologic department of a university teaching hospital . PATIENT(S ) Women booked for laparoscopic excision of endometriosis . INTERVENTION(S ) Intraoperative multimodal analgesia versus placebo . Analgesia consisted of Diclofenac sodium 100 mg suppository per rectum and 0.75 % Ropivacaine to portal sites , subperitoneally under excision sites and topically to each subdiaphragmatic area . MAIN OUTCOME MEASURE(S ) Postoperative total hospital opioid analgesic requirements and postoperative pain intensity . RESULT ( S ) The study was terminated prematurely , after a planned interim analysis ( which included 66 r and omized patients or 43 % of the planned number of patients ) found significantly less total hospital opioid requirements in the analgesic group compared with the placebo group ( 19.0 mg vs. 34.5 mg ; difference -14.0 mg [ 95 % confidence interval -26.0 to -2.0 mg ] ) . There was no difference in postoperative pain intensity between the two groups . CONCLUSION ( S ) The use of multimodal intraoperative analgesia at laparoscopic excision of endometriosis reduces postoperative opioid requirements OBJECTIVE The intraperitoneal route of analgesia has been studied over the years for effective perioperative pain relief during minimally invasive surgery , but there were conflicting reports of the use of intraperitoneal analgesic administration and moreover there was no consensus regarding the dose and type of drugs used . We report a r and omized trial to assess the safety and effectiveness of intraperitoneal lignocaine as an intraoperative and postoperative analgesic in laparoscopic tubal ligation . STUDY DESIGN This is a double masked , r and omized parallel group placebo-controlled trial of women seeking laparoscopic sterilization under local anaesthesia at a university hospital . The intervention group and placebo group received 20 ml of 0.5 % lignocaine and 20 ml of isotonic saline intraperitoneally respectively . Allocation concealment was done by fixed block r and omization . The participating women , the surgeon , anaesthetist , technician and the doctor who assessed the pain score were masked to the type of intervention . Intraoperative and postoperative pain was assessed by visual analogue pain scale and the scores are expressed as mean difference ( 95 % confidence interval ) between groups . Our trial is registered with the Clinical Trials Registry , India ( http://www.ctri.nic.in/ , CTRI/2009/091/000072 ) . RESULTS Out of 200 women recruited , 196 were available for final analysis with 98 women in each arm . The mean difference in the intraoperative pain score at the time of tubal ligation was 3.5 cm ( 95 % CI 2.91 - 4.09 ) . The mean difference in the postoperative pain scores at half an hour was 2.9 ( 95 % CI 2.50 - 3.44 ) , 1h was 2.5 ( 95 % CI 2.08 - 3.00 ) and 3h was 1.2 ( 95 % CI 0.75 - 1.76 ) . There was no case of adverse reaction to lignocaine . CONCLUSION Our findings show that intraperitoneal instillation of lignocaine is a safe and effective method for perioperative pain relief during laparoscopic tubal occlusion performed under conscious sedation OBJECTIVE To assess the effect of intraperitoneal instillation of lidocaine on postoperative pain after minor gynecological laparoscopic surgery . METHOD A prospect i ve , double-blind , placebo-controlled clinical trial of 75 patients undergoing gynecological laparoscopy r and omized to receive intraperitoneal instillation of either 120 mg of lidocaine ( n=60 ) or normal saline ( n=15 ) at the end of surgery . Postoperative pain was evaluated by Wong-Baker Faces Pain Rating Scale ( WBFS ) score at 15 minutes and at 1 , 2 , 4 , 12 , and 24 hours postoperatively . RESULTS The WBFS score was lower for the lidocaine group than for the control group at 1 , 2 , and 4 hours after surgery ( P=0.023 ) . There was no difference in WBFS scores between the 2 groups at 15 minutes ( P=0.46 ) , 12 hours ( P=0.13 ) , and 24 hours ( P=0.07 ) after surgery . CONCLUSION Intraperitoneal instillation of lidocaine was effective in reducing postoperative pain after minor gynecological laparoscopic procedures Abstract Laparoscopic examination is useful in the evaluation of infertile women . To perform this test , pneumoperitoneum is required to distend the abdomen , improve visibility and displace the intestines out of the pelvis . Several gases have been used to achieve this purpose including nitrous oxide ( N2O ) , carbon dioxide ( CO2 ) , helium , xenon and air . This is a prospect i ve study in a private fertility centre comparing CO2 and room air pneumoperitoneum for diagnostic laparoscopy . Also the safety of room air was evaluated . One hundred and forty five patients received  CO2  ( group 1 , n = 73 ) or room air ( group 2 , n = 72 ) pneumoperitoneum . Ketamine anaesthesia was used for all the patients and the cost of the procedure was same for the study . CO2 pneumoperitoneum offered better visibility during laparoscopy and the patients also had a better outcome : Wound infection ( CO2 – 2/73 : 2.7 % Vs . Air – 11/72 : 15.3 % ) ; abdominal discomfort ( feeling of retained gas in the abdomen ) CO2 – 5/73 : 6.9 % Vs . Air – 61/72 : 84.7 % ) and shoulder pain ( CO2 – 0/73 ; 0.0 % Vs . Air – 56/72 : 77.8 % ) . Group 1 patients returned to normal activity earlier ( 1.5 days ± 1.3 SD Vs . 4.8 days ± 2.1 SD ) . We conclude that CO2 pneumoperitoneum has a better outcome than Air especially for day-case diagnostic laparoscopy . However , room Air pneumoperitoneum is safe , cheap , and available and may be recommended for low re source setting Abstract Aim To evaluate the efficacy of intraperitoneal bupivacaine to reduce post operative pain after diagnostic minilaparoscopy in patients with infertility . Design A prospect i ve r and omized study was performed . Material s and methods The study group consisted of 104 women with infertil 
    Output:
    
AUTHORS ' CONCLUSIONS There is low to moderate- quality evidence that the following interventions are associated with a reduction in the incidence or severity , or both , of STP , or a reduction in analgesia requirements for women undergoing gynaecological laparoscopy : a specific technique for releasing the pneumoperitoneum ; intraperitoneal fluid instillation ; an intraperitoneal drain ; and local anaesthetic applied to the peritoneal cavity ( not subdiaphragmatic).There is low to moderate- quality evidence that subdiaphragmatic intraperitoneal local anaesthetic and warmed and humidified insufflating gas may not make a difference to the incidence or severity of STP.There is low- quality evidence that gasless laparoscopy may increase the severity of STP , compared with st and ard treatment .