***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: The efficacy of oral ketorolac 5 mg and 10 mg taken qid was compared in a r and omized double-blind study with that of oral diflunisal 500 mg bid ( interleaved with placebo twice daily ) and of placebo , in 120 patients suffering at least moderate pain following meniscectomy . The trial comprised two phases : ( 1 ) an acute phase ( the first postoperative day ) and ( 2 ) a chronic phase ( days 2 - 5 postoperatively ) . Acutely , pain was assessed before drug administration , and then 0.5 , 1.0 , 2.0 , 3.0 , 4.0 , 6.0 , 8.0 , and 9.0 hours after the first dose . The second of the four daily doses was administered at four hours after the first dose . During the chronic phase , pain was assessed using visual analogue scales at 8 AM and 4 PM daily . The acute phase results show that all the active treatments were statistically significantly superior to placebo but were not distinguished from each other . Over the chronic phase , ketorolac 5 mg and placebo showed similar results , with diflunisal showing the least pain relief and ketorolac 10 mg the most . All the active treatments showed a low incidence of side effects and , in an overall evaluation , no one treatment was distinguishable . Ketorolac would seem to be an acceptable therapy for acute postoperative pain Abstract  Variability  in patients ' response to interventions in pain and other clinical setting s is large . Many explanations such as trial methods , environment or culture have been proposed , but this paper sets out to show that the main cause of the variability may be r and om chance , and that if trials are small their estimate of magnitude of effect may be incorrect , simply because of the r and om play of chance . This is highly relevant to the questions of ‘ How large do trials have to be for statistical accuracy ? ’ and ‘ How large do trials have to be for their results to be clinical ly valid ? ’ The true underlying control event rate ( CER ) and experimental event rate ( EER ) were determined from single‐dose acute pain analgesic trials in over 5000 patients . Trial group size required to obtain statistically significant and clinical ly relevant ( 0.95 probability of number‐needed‐to‐treat within ±0.5 of its true value ) results were computed using these values . Ten thous and trials using these CER and EER values were simulated using varying group sizes to investigate the variation due to r and om chance alone . Most common analgesics have EERs in the range 0.4–0.6 and CER of about 0.19 . With such efficacy , to have a 90 % chance of obtaining a statistically significant result in the correct direction requires group sizes in the range 30–60 . For clinical relevance nearly 500 patients are required in each group . Only with an extremely effective drug ( EER>0.8 ) will we be reasonably sure of obtaining a clinical ly relevant NNT with commonly used group sizes of around 40 patients per treatment arm . The simulated trials showed substantial variation in CER and EER , with the probability of obtaining the correct values improving as group size increased . We contend that much of the variability in control and experimental event rates is due to r and om chance alone . Single small trials are unlikely to be correct . If we want to be sure of getting correct ( clinical ly relevant ) results in clinical trials we must study more patients . Credible estimates of clinical efficacy are only likely to come from large trials or from pooling multiple trials of conventional ( small ) size This multicenter study compared the analgesic efficacy and side effects of ketorolac and hydrocodone-acetaminophen when administered orally after ambulatory arthroscopic or laparoscopic tubal ligation procedures . After awakening from general anesthesia , 252 patients experiencing moderate or severe postoperative pain were r and omly assigned to receive one of three analgesic treatments according to a placebocontrolled , double-blind protocol . Group 1 ( n = 83 ) received oral ketorolac 10 mg every 6 h for up to 3 days , Group 2 ( n = 82 ) received hydrocodone 7.5 mg plus acetaminophen 750 mg every 6 h for up to 3 days , and Group 3 ( n = 87 ) received placebo capsules followed by ketorolac 10 mg every 6 h for up to 3 days . Severity of pain was recorded using a 4-point categorical score and visual analog scale ( VAS ) at 0.5 h and subsequently at hourly intervals for 6 h , as well as daily for up to 3 days . Pain relief was recorded using a 5-point categorical scale at the same time points . In the patients undergoing arthroscopic surgery , both ketorolac and hydromorphone-acetaminophen provided superior pain relief compared with the placebo . Although the categorical summed pain intensity difference ( SPID ) , VASSPID , and total pain relief scores were higher in the ketorolac group compared with the hydrocodone-acetaminophen group , the differences were not statistically significant . In the patients undergoing laparoscopic tubal ligation surgery , the three treatment groups displayed similar responses to the study medications . However , the ketorolac group scored higher in terms of overall tolerability than the hydrocodone-acetaminophen group . In conclusion , there was no difference in the efficacy between oral ketorolac and hydrocodone-acetaminophen combination in controlling pain after outpatient arthroscopic surgery procedures . Neither oral analgesic proved to be very effective after laparoscopic tubal ligation . ( Anesth Analg 1997;85:37 - 43 The analgesic efficacy and side-effects of a single parenteral dose of metkephamid acetate 70 mg were compared with those of pethidine ( meperidine ) hydrochloride 100 mg and placebo in a double-blind , r and omised , controlled clinical trial . 30 out of 32 postoperative patients completed the study --10 in the metkephamid group , 11 in the pethidine group , and 9 in the placebo group . The time-effect curves of summated pain measures and analyses of derived measures all indicated that the analgesic activity of metkephamid 70 mg was significantly greater than that of placebo and not less than that of pethidine 100 mg . The metkephamid group had a greater incidence of side-effects than the other two treatment groups . Some side-effects , such as sensations of heaviness of the extremities and nasal congestion , were peculiar to metkephamid but not distressing Overemphasis on hypothesis testing-- and the use of P values to dichotomise significant or non-significant results --has detracted from more useful approaches to interpreting study results , such as estimation and confidence intervals . In medical studies investigators are usually interested in determining the size of difference of a measured outcome between groups , rather than a simple indication of whether or not it is statistically significant . Confidence intervals present a range of values , on the basis of the sample data , in which the population value for such a difference may lie . Some methods of calculating confidence intervals for means and differences between means are given , with similar information for proportions . The paper also gives suggestions for graphical display . Confidence intervals , if appropriate to the type of study , should be used for major findings in both the main text of a paper and its abstract In a double-blind , placebo-controlled study , 207 patients with moderate pain after surgical removal of impacted third molars were r and omly assigned to receive a single oral dose of 10 mg of ketorolac tromethamine , 10 mg of hydrocodone plus 1000 mg of acetaminophen , or placebo .  Analgesic effect as assessed by summed pain intensity difference at 3 and 6 hours was significantly ( P < or = 0.01 ) greater after ketorolac than after hydrocodone/acetaminophen .  Total pain relief at 3 and 6 hours was significantly ( P < 0.026 ) greater after ketorolac than after hydrocodone/acetaminophen or placebo . Patients taking hydrocodone/acetaminophen  remedicated significantly ( P = 0.027 ) sooner than those taking ketorolac . In this single-dose study , adverse events were reported more frequently by patients taking hydrocodone/acetaminophen than with ketorolac or placebo . It is concluded that , in this pain model , 10 mg of ketorolac affords better pain relief with fewer side effects than hydrocodone/acetaminophen Abstract A previously established relationship for deriving dichotomous from continuous information in r and omised controlled trials ( RCTs ) of analgesics has been tested using an independent data set . Individual patient information from 18 RCTs of parallel‐group design in acute postoperative pain ( after abdominal , gynaecological and oral surgery ) was used to calculate the percentage of the maximum possible pain relief score  ( % maxTOTPAR ) and the proportion of patients with > 50%maxTOTPAR for the different treatments . The relationship between the measures was investigated in 85 treatments with over 3400 patients . In 80 of 85 treatments ( 94 % ) agreement between calculated and actual number of patients with > 50%maxTOTPAR was within four patients per treatment and in 72 ( 85 % ) was within three ( average of 40 patients per treatment , range 21–58 patients ) . Summing the positive and negative differences between actual and calculated numbers of patients with > 50%maxTOTPAR gave an average difference of 0.30 patients per treatment arm . Reports of RCTs of analgesics frequently describe results of studies in the form of mean derived indices , rather than using discontinuous events , such as number or proportion of patients with 50 % pain relief . Because mean data inadequately describe information with a non‐normal distribution , combining mean data in systematic review s may compromise the results . Showing that dichotomous data can reliably be derived from mean data in acute pain studies enables data published as means to be used for quantitative systematic review s which require data in dichotomous form The aim of the present study was to investigate the dose-effect relationship of single doses of 4 to 32 mg of lornoxicam ( LNX ) , a new nonsteroidal antiinflammatory drug belonging to the oxicam group , compared with placebo and 10 mg ketorolac ( KET ) in the treatment of pain after oral surgery . Also , it was the aim of the study to evaluate the relationship between adverse events and different doses of LNX . After the surgical removal of a m and ibular third molar , test medication was taken when the patients experienced at least moderate pain . After medication , pain relief , pain intensity , and any discomfort from the medication were noted in a question naire . Paracetamol was used as rescue medication . A total of 278 patients completed the study according to the protocol . The primary efficacy parameter was total pain relief after 6 hours , and all active treatments showed significantly better effect than placebo , with LNX 16 and 32 mg being significantly superior to LNX 4 mg . All other efficacy parameters showed the same dose-effect relationship . A total of 37 adverse events were reported evenly distributed in the 6 treatment groups ; only 3 of these were considered severe , and all disappeared without treatment . In conclusion , the study showed a dose-effect relationship of LNX without a rise in adverse events . The effect of 10 mg KET seemed to be at the level of 8 to 16 mg LNX Two-hundred six out patients with postoperative pain after the surgical removal of impacted third molars were r and omly assigned on a double-blind basis to receive oral doses of ketorolac tromethamine 10 and 20 mg , ibuprofen 400 mg , acetaminophen 600 mg , a combination of acetaminophen 600 mg plus codeine 60 mg , or placebo . Using a self-rating record , subjects rated their pain and its relief hourly for 6 hours after medicating . All active medications were significantly superior to placebo .  Analgesia was similar for ketorolac 10 and 20 mg and ibuprofen 400 mg ; however , these treatments were superior to acetaminophen alone and the acetaminophen-codeine combination . The analgesic effect of each active medication was significant by hour 1 and persisted for 5 - 6 hours . The data suggest a plateau in  ketorolac 's analgesic efficacy at the 10-mg level . Repeat-dose data indicated that on the day of surgery ketorolac 10 and 20 mg and ibuprofen 400 mg were superior to acetaminophen 600 mg ; ketorolac 20 mg was also superior to acetaminophen-codeine . Differences among active medications were not significant when data for the entire postoperative period ( days 0 - 6 ) were evaluated . The frequency of adverse effects was similar for the active medications The analgesic efficacy and safety of single doses of 10 mg and 30 mg ketorolac tromethamine and 100 mg pethidine were evaluated in a double-blind , parallel-group study . The drugs were administered intramuscularly to patients experiencing moderate , severe or very severe pain immediately following major abdominal surgery . A total of 129 patients were r and omly assigned to receive either active drug ( n = 32 for each treatment group ) or placebo ( n = 33 ) , and the patients assessed pain intensity and pain relief on a visual analogue scale at regular intervals over the following 8 h. During the first 2 h , pethidine had a more rapid onset of action than ketorolac or placebo , and thereafter 100 mg pethidine and 30 mg ketorolac were equally effective . Ketorolac , at a dose of 
    Output:
    
Oral ketorolac 10 mg was consistently at least as effective as ketorolac 30 mg i.m .