human
***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 : The aims of the study were to evaluate costs and clinical characteristics of desflurane‐based anaesthetic maintenance versus propofol for outpatient cholecystectomy 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 Sixteen otherwise healthy women undergoing cholecystectomy were r and omized to receive postoperative analgesia either by continuous infusion of papaveretum  ( n = 8) , or by continuous interpleural infusion of bupivacaine  ( n = 8) . Postoperative pain was assessed by linear analogue and ventilatory capacity . Changes in body protein were measured by in vivo neutron activation analysis . Clinical course was also noted . Pain scores were significantly lower in the interpleural group over the first 48 h ( P less than 0.02 ) . Ventilatory capacity was also significantly better for the first 24 h ( P less than 0.025 ) . There was no evidence of shortened postoperative ileus ; hospital stay and postoperative fatigue were similar for the two groups . Weight and protein losses over a 2 week period were similar in the two groups . It is concluded that the apparent advantages in patient comfort and mobility offered by interpleural infusion are most marked in the first 48 h postoperatively , with an advantage in ventilatory capacity over the first 24 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 A r and omized , double-blind , placebo-controlled study of buprenorphine was carried out in 20 patients after cholecystectomy . The drug was given on " patient dem and " either i.m . ( 0.15 mg ) or sublingually ( 0.2 mg ) with a minimum dose interval of 30 min . Over the 24-h study period the mean dem and by the sublingual route was 0.8 mg ( range 0.6 - 1.2 mg ) and by the i.m . route 0.66 mg ( range 0.45 - 0.9 mg ) . Pain relief , by visual analogue scales and grading , was similar . Plasma buprenorphine concentrations varied more after sublingual administration . Either route was effective for the treatment of pain when administered by " patient dem and " We have compared , in a r and omized study , conventional carbon dioxide pneumoperitoneum with abdominal wall lift in 25 patients undergoing laparoscopic cholecystectomy .  Intra-abdominal pressure ( IAP ) ( 11 ( SD 2 ) mm Hg vs 2.7 ( 9 ) mm Hg ) ( P < 0.01 ) and total amount of carbon dioxide used ( 40 ( 23 ) litre vs 9 ( 7 ) litre ) ( P < 0.001 ) were significantly less with abdominal wall lift . Pulmonary compliance was significantly greater ( P < 0.01 ) in the abdominal wall lift group throughout operation . During the first 15 min of insufflation , arterial pressures were lower with abdominal wall lift ( P < 0.05 ) . In the conventional pneumoperitoneum group , femoral vein pressure increased ( P < 0.01 ) and remained elevated for 3 h in the recovery room . Postoperative drowsiness was of significantly longer duration in the conventional pneumoperitoneum group than in the abdominal wall lift group ( 98 ( 46 ) min vs 13 ( 34 ) min ) ( P < 0.01 ) . Postoperative nausea and vomiting and right shoulder pain occurred more often in patients with conventional pneumoperitoneum ( P < 0.05 ) . We conclude that the benefits of abdominal wall lift may be attributed to avoiding excessive carbon dioxide and high IAP 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 It is postulated that laparoscopic cholecystectomy as “ patient-friendly surgery ” leads to more comfort and in particular to less pain . A prospect i ve study on pain was performed on all patients undergoing the operation over the period of 1 year ( n=382 ) out of a series of more than 1,000 patients who have undergone the operation in our clinic .  Pain was measured by a 100-point visual analogue scale ( VAS ) , by a five-point verbal rating scale , and by the  consumption of analgesics . Pain was the most frequent symptom , both before and after the operation . The mean level of pain was 37 VAS points 5 h after the operation and declined to 16 points on the third day . In 106 patients ( 27.8 % ) the intensity of pain was higher than 50 VAS points . Analgesics  were used by 282 patients ( 73.8 % ) , opioids by 112 ( 29.3 % ) . Pain was significantly higher in female than male patients ( P<0.05 ) , but consumption of analgesics was similar in both groups . The most severe pain was localized to the abdominal wall wounds by 157 ( 41.1 % ) and to the right upper abdomen by 138 patients ( 36.1 % ) on the first postoperative day . Patients who needed  opioids  and /or had a pain level of > 50 VAS points ( n=138 ) had higher preoperative pain levels ( P=0.018 ) and preoperatively complained more frequently about nausea , vomiting , bloating , and a feeling of abdominal pressure ( P=0.003–0.031 ) . However , predictive values of these variables were too small to be of clinical benefit . The duration of operation , intraoperative events ( loss of bile , blood , or gallstones ) , and additional laparoscopic procedures ( adhesiolysis , lavage , extension of an incision , suture of fascia ) did not influence the intensity of postoperative pain . We conclude that laparoscopic cholecystectomy did cause significant postoperative pain in one-third of our patients only up to the first postoperative day . As predictors for high intensity of pain were not identified , pain should be monitored and analgesics should be delivered liberally Background Although laparoscopic cholecystectomy ( LC ) results in less pain then open cholecystectomy , it is not a pain-free procedure . The aim of this study was to test a new method of preemptive analgesia . Methods By simple r and omization 60 patients were assigned to two groups ( 30 in each group ) . Group A , the placebo group , received 200 ml of 0.9 % saline , and group B received 5 mg/kg of a local anesthetic solution ( ropivacaine ) in 200 ml of 0.9 % saline . Local anesthetic or place solution were administer before creation of the pneumoperitoneum . Results Pain intensity , as rated by visual analog and verbal rating scales , and stress response data were significantly less in the group receiving ropivacaine than in the placebo group . No patients in treatment group received an additional dose of analgesic , whereas two patients in placebo group needed an additional analgesic . Conclusions Our results support the clinical validity of preemptive analgesia , but the timing of intraperitoneal administration of local anesthetic is very important . Only application before creation of the pneumoperitoneum may preempt every neuronal central sensitization 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 
    Output:
    
agent
This approach has been design ed to provide adequate analgesia while minimizing exposure to adverse events
***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 : The aims of the study were to evaluate costs and clinical characteristics of desflurane‐based anaesthetic maintenance versus propofol for outpatient cholecystectomy 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 Sixteen otherwise healthy women undergoing cholecystectomy were r and omized to receive postoperative analgesia either by continuous infusion of papaveretum  ( n = 8) , or by continuous interpleural infusion of bupivacaine  ( n = 8) . Postoperative pain was assessed by linear analogue and ventilatory capacity . Changes in body protein were measured by in vivo neutron activation analysis . Clinical course was also noted . Pain scores were significantly lower in the interpleural group over the first 48 h ( P less than 0.02 ) . Ventilatory capacity was also significantly better for the first 24 h ( P less than 0.025 ) . There was no evidence of shortened postoperative ileus ; hospital stay and postoperative fatigue were similar for the two groups . Weight and protein losses over a 2 week period were similar in the two groups . It is concluded that the apparent advantages in patient comfort and mobility offered by interpleural infusion are most marked in the first 48 h postoperatively , with an advantage in ventilatory capacity over the first 24 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 A r and omized , double-blind , placebo-controlled study of buprenorphine was carried out in 20 patients after cholecystectomy . The drug was given on " patient dem and " either i.m . ( 0.15 mg ) or sublingually ( 0.2 mg ) with a minimum dose interval of 30 min . Over the 24-h study period the mean dem and by the sublingual route was 0.8 mg ( range 0.6 - 1.2 mg ) and by the i.m . route 0.66 mg ( range 0.45 - 0.9 mg ) . Pain relief , by visual analogue scales and grading , was similar . Plasma buprenorphine concentrations varied more after sublingual administration . Either route was effective for the treatment of pain when administered by " patient dem and " We have compared , in a r and omized study , conventional carbon dioxide pneumoperitoneum with abdominal wall lift in 25 patients undergoing laparoscopic cholecystectomy .  Intra-abdominal pressure ( IAP ) ( 11 ( SD 2 ) mm Hg vs 2.7 ( 9 ) mm Hg ) ( P < 0.01 ) and total amount of carbon dioxide used ( 40 ( 23 ) litre vs 9 ( 7 ) litre ) ( P < 0.001 ) were significantly less with abdominal wall lift . Pulmonary compliance was significantly greater ( P < 0.01 ) in the abdominal wall lift group throughout operation . During the first 15 min of insufflation , arterial pressures were lower with abdominal wall lift ( P < 0.05 ) . In the conventional pneumoperitoneum group , femoral vein pressure increased ( P < 0.01 ) and remained elevated for 3 h in the recovery room . Postoperative drowsiness was of significantly longer duration in the conventional pneumoperitoneum group than in the abdominal wall lift group ( 98 ( 46 ) min vs 13 ( 34 ) min ) ( P < 0.01 ) . Postoperative nausea and vomiting and right shoulder pain occurred more often in patients with conventional pneumoperitoneum ( P < 0.05 ) . We conclude that the benefits of abdominal wall lift may be attributed to avoiding excessive carbon dioxide and high IAP 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 It is postulated that laparoscopic cholecystectomy as “ patient-friendly surgery ” leads to more comfort and in particular to less pain . A prospect i ve study on pain was performed on all patients undergoing the operation over the period of 1 year ( n=382 ) out of a series of more than 1,000 patients who have undergone the operation in our clinic .  Pain was measured by a 100-point visual analogue scale ( VAS ) , by a five-point verbal rating scale , and by the  consumption of analgesics . Pain was the most frequent symptom , both before and after the operation . The mean level of pain was 37 VAS points 5 h after the operation and declined to 16 points on the third day . In 106 patients ( 27.8 % ) the intensity of pain was higher than 50 VAS points . Analgesics  were used by 282 patients ( 73.8 % ) , opioids by 112 ( 29.3 % ) . Pain was significantly higher in female than male patients ( P<0.05 ) , but consumption of analgesics was similar in both groups . The most severe pain was localized to the abdominal wall wounds by 157 ( 41.1 % ) and to the right upper abdomen by 138 patients ( 36.1 % ) on the first postoperative day . Patients who needed  opioids  and /or had a pain level of > 50 VAS points ( n=138 ) had higher preoperative pain levels ( P=0.018 ) and preoperatively complained more frequently about nausea , vomiting , bloating , and a feeling of abdominal pressure ( P=0.003–0.031 ) . However , predictive values of these variables were too small to be of clinical benefit . The duration of operation , intraoperative events ( loss of bile , blood , or gallstones ) , and additional laparoscopic procedures ( adhesiolysis , lavage , extension of an incision , suture of fascia ) did not influence the intensity of postoperative pain . We conclude that laparoscopic cholecystectomy did cause significant postoperative pain in one-third of our patients only up to the first postoperative day . As predictors for high intensity of pain were not identified , pain should be monitored and analgesics should be delivered liberally Background Although laparoscopic cholecystectomy ( LC ) results in less pain then open cholecystectomy , it is not a pain-free procedure . The aim of this study was to test a new method of preemptive analgesia . Methods By simple r and omization 60 patients were assigned to two groups ( 30 in each group ) . Group A , the placebo group , received 200 ml of 0.9 % saline , and group B received 5 mg/kg of a local anesthetic solution ( ropivacaine ) in 200 ml of 0.9 % saline . Local anesthetic or place solution were administer before creation of the pneumoperitoneum . Results Pain intensity , as rated by visual analog and verbal rating scales , and stress response data were significantly less in the group receiving ropivacaine than in the placebo group . No patients in treatment group received an additional dose of analgesic , whereas two patients in placebo group needed an additional analgesic . Conclusions Our results support the clinical validity of preemptive analgesia , but the timing of intraperitoneal administration of local anesthetic is very important . Only application before creation of the pneumoperitoneum may preempt every neuronal central sensitization 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 
    Output:
    