***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: OBJECTIVE To investigate and compare the effectiveness of preincisional peritonsillar infiltration of ketamine and tramadol for post-operative pain on children following adenotonsillectomy .  STUDY DESIGN Prospect i ve r and omized double blind controlled study . METHODS Seventy-five children aged 3 - 10 years undergoing adenotonsillectomy were included in study . Patients received injections in peritonsillar fossa of tramadol ( 2 mg/kg-2 ml ) , ketamine ( 0.5 mg/kg-2 ml ) or 2 ml serum physiologic . During operation heart rate , oxygen saturation , average mean blood pressures were recorded in every 5 min . Operation , anesthesia and the time that Alderete scores 9 - 10 , patient satisfaction , analgesic requirements were recorded . Postoperatively nausea , vomiting , sedation , dysphagia , bleeding scores were recorded at 0 , 10 , 30 , 60 min and 2 , 4 , 8 , 12 , 18 , 24h postoperatively . Pain was evaluated using modified Children 's Hospital of Eastern Ontario Pain Scale ( mCHEOPS ) at fixed intervals after the procedure ( 15 min and 1 , 4 , 12 , 16 , and 24h postoperatively ) . RESULTS The recordings of heart rate , mean arterial pressure , nausea , vomiting , sedation and bleeding scores were similar in all groups ( p>0.05 ) . The mCHEOPS scores at 10 min , 30 min , 1h , 8h were significantly lower in both tramadol and ketamine group when compared with control ( p<0.05 ) . Use of additional analgesia at 10 min and 18 h were higher in control group than ketamine , tramadol group ( p<0.05 ) . Dysphagia scores were significantly lower for both ketamine and tramadol group when compared with control group ( p<0.05 ) . mCHEOPS , additional analgesia , dysphagia , patient satisfaction scores were similar in tramadol , ketamine groups ( p>0.05 ) . CONCLUSIONS Preincisional injection of ketamine and tramadol prior to tonsillectomy is safe , effective method and equivalent for post-tonsillectomy pain , patient satisfaction , postoperative nausea , vomiting , dysphagia Objective To test the feasibility of research on acupuncture and acupressure for children undergoing tonsillectomy and /or adenoidectomy . Methods During January and February 2008 , 20 patients from the ordinary waiting list at Lovisenberg Diakonale Hospital in Oslo were r and omised to either acupuncture while under anaesthesia or st and ard care as control . The authors gave acupuncture at Pericardium 6 ( P6 ) at a depth of approximately 0.7 cm on both forearms . The needles were removed when the patient was transferred to the recovery unit and replaced with acupressure wristb and s. The outcome measure in the pilot study was to explore if acupuncture and acupressure could be implemented without extending the anaesthesia time and surgical time . This pilot study also tested the feasibility of the research protocol for future investigation in the field , with postoperative nausea , vomiting and retching as the primary end points for effect . Results The study showed no delay in the surgical procedure and no additional anaesthesia time attributable to the introduction of acupuncture . The protocol was found to be feasible with regard to performance of the main study . Vomiting occurred in five patients in the treatment group and 10 patients in the control group . The total numbers of vomiting events were 13 in the treatment group and 19 in the control group . Conclusion The results encouraged performance of the main study according to the research protocol Introduction :  Tonsillectomy  is one of the most common surgeries in the world and the most common problem is post-tonsillectomy pain and bleeding . The relief of postoperative pain helps increase early food intake and prevent secondary dehydration . One method for relieving pain is peritonsillar injection of epinephrine along with an anesthetic , which has been shown to produce variable results in previous studies . Study Deign : Prospect i ve case-control study . Setting : A tertiary referral centers with accredited otorhinolaryngology-head & neck surgery and anesthesiology department . Material s and Methods : Patients under 15 years old , who were tonsillectomy c and i date s , were assigned into one of three groups : placebo injection , drug injection before tonsillectomy , and drug injection after tonsillectomy . The amount of bleeding , intensity of pain , and time of first post-operative food intake were evaluated during the first 18 hours post operation . Results : The intensity of pain in the first 30 minutes after the operation was lower in the patients who received injections , but the difference was not significant during the first 18 hours . The intensity of pain on swallowing during the first 6 hours was also lower in the intervention groups as compared with the placebo group . The amount of bleeding during the first 30 minutes post operation was lower in the two groups who received injections , but after 30 minutes there was no difference . Conclusion : Injection of epinephrine and bupivacaine pre- or post- tonsillectomy is effective in reducing pain and bleeding . The treatment also decreases swallowing pain in the hours immediately after surgery Objective To investigate the effectiveness of acupuncture and acupressure as supplements to st and ard treatment for postoperative vomiting  in children undergoing tonsillectomy and /or adenoidectomy . Methods A pragmatic , open , block-r and omised controlled trial . The results were analysed according to the intention-to-treat principle . The study was conducted without extra re sources in a normal setting at the day-surgery department of Lovisenberg Diakonale Hospital in Oslo . 154 children with an American Society of Anesthesiologists grade 1–2 , weighing at least 10 kg , were included . Children with concomitant gastrointestinal diseases , emesis or antiemetic treatment < 24 h preoperatively , rash or local infection over the actual acupuncture points were excluded together with patients whose parents ’ informed consent could not be obtained . The intervention group received acupuncture at pericardium 6 bilaterally , at a depth of approximately 0.7 cm with a median of 21 min during anaesthesia , followed by acupressure wristb and s for 24 h and st and ard treatment . The control group received st and ard treatment . The primary end point was the occurrence of vomiting or retching during 24 h postoperatively . Results Children in the acustimulation group experienced less retching and vomiting than the control group—46.8 % versus 66.2 % ( p=0.015 ) . The effect of acustimulation was specifically pronounced in girls and children aged 1–3 years . Conclusion This trial indicates the effectiveness of acustimulation as an adjunct to st and ard treatment . The results should encourage and promote the implementation of acustimulation for postoperative vomiting in children undergoing adenoidectomy or tonsillectomy OBJECTIVES /HYPOTHESIS To evaluate the effect of intraoperative acupuncture on posttonsillectomy pain in the pediatric population . STUDY DESIGN Prospect i ve , double-blind , r and omized , placebo-controlled trial . METHODS Patients aged 3 to 12 years undergoing tonsillectomy were recruited at a tertiary children 's hospital between February 2011 and May 2012 . Participants were block-r and omized to receive acupuncture or sham acupuncture during anesthesia for tonsillectomy . Surgeons , staff , and parents were blinded from treatment . Tonsillectomy was performed by one of two surgeons using a st and ard technique ( monopolar cautery ) , and a single anesthetic protocol was followed . Study endpoints included time spent in the postanesthesia care unit , the amount of opioids administered in the perioperative period , and pain measures and presence of nausea/vomiting from postoperative home surveys . RESULTS Fifty-nine children aged 3 to 12 years were r and omized to receive acupuncture ( n = 30 ) or sham acupuncture ( n = 29 ) . No significant demographic differences were noted between the two cohorts . Perioperative data were recorded for all patients ; 73 % of patients later returned home surveys . There were no significant differences in the amount of opioid medications administered or total postanesthesia care unit time between the two cohorts . Home surveys of patients but not of parents revealed significant improvements in pain control in the acupuncture treatment-group postoperatively ( P = 0.0065 and 0.051 , respectively ) , and oral intake improved significantly earlier in the acupuncture treatment group ( P = 0.01 ) . No adverse effects of acupuncture were reported . CONCLUSIONS This study demonstrates that intraoperative acupuncture is feasible , well tolerated , and results in improved pain and earlier return of diet postoperatively . LEVEL OF EVIDENCE 1b Background The results of many clinical trials and experimental studies regarding acupoint specificity are contradictory . This review aims to investigate whether a difference in efficacy exists between ordinary acupuncture  on specific acupoints and sham acupuncture controls on non-acupoints or on irrelevant acupoints . Methods Data bases including Medline , Embase , AMED and Chinese Biomedical Data base were search ed to identify r and omized controlled trials published between 1998 and 2009 that compared  traditional body acupuncture  on acupoints  with sham acupuncture controls  on irrelevant acupoints or non-acupoints with the same needling depth . The Cochrane Collaboration 's tool for assessing risk of bias was employed to address the quality of the included trials . Results Twelve acupuncture clinical trials with sham acupuncture controls were identified and included in the review . The conditions treated varied . Half of the included trials had positive results on the primary outcomes and demonstrated acupoint specificity . However , among those six trials ( total sample size : 985 ) with low risk of bias , five trials ( sample size : 940 ) showed no statistically significant difference between proper and sham acupuncture treatments . Conclusion This review did not demonstrate the existence of acupoint specificity . Further clinical trials with larger sample sizes , optimal acupuncture treatment protocol s and appropriate sham acupuncture controls are required to resolve this important issue Post-tonsillectomy swallowing pain is a common and distressing side effect after  tonsillectomy  and thus of great clinical interest . Up until now , there is no r and omized controlled patient- and observer-blinded study evaluating the efficacy of acupuncture against swallowing pain after tonsillectomy . We therefore compared the potency of specific verum acupuncture points related to a Chinese medical diagnosis in reducing postoperative swallowing pain with non-specific control points on the body as well as a non-acupuncture group who received st and ard medication only . The st and ardized pain therapy after tonsillectomy was orally administered nonsteroidal anti-inflammatory drugs ( NSAID ) ( diclofenac 3 × 50 mg oral ) . The patients ( n = 123 ) treated with NSAID were asked about their acute pain after taking a sip of water between the first and fifth postoperative day .  Participants ’ pain was assessed using visual analog ( VAS ) [ zero ( 0 ) for no pain up to ten ( 10 ) for the acute reported outset pain ] before and 20 min , 1 , 2 and 3 h after acupuncture treatment or st and ard pain medication , respectively . The functional assessment of diagnosis and treatment point-combination occurred by means of the “ Heidelberg Model ” of Traditional Chinese Medicine ( TCM ) . Verum acupuncture lead to a significant additional pain relief . In comparison to the acupuncture , they also reported an average of 3 h duration of adequate pain-relief past taking the NSAID . This trial strongly supports a specific acupuncture scheme for the treatment of postoperative swallowing pain after tonsillectomy . It may particularly serve as an alternative pain treatment in case of NSAID intolerances Objectives To investigate the effect of a st and ardised acupuncture on nausea and vomiting in children after tonsillectomy with or without adenoidectomy when possible placebo effects were precluded . Methods A pragmatic , multicentre , double-blinded , r and omised controlled trial . The study was conducted over 10 months in 2012–2013 at three ambulatory clinics . Two hundred and eighty-two children , age 1–11 years , American Society of Anesthesiologists grade ≤II , were included . To equalise expectancy effects , all parents were told that their child would receive acupuncture . However , children were r and omly allocated to perioperative bilateral needling acupuncture at PC6 , depth 7 mm , mean time 17 min ( SD 5–45 ) during anaesthesia plus usual care , or to usual care only . The regional ethics committee approved this approach . Primary endpoints were nausea and vomiting 24 h postoperatively . Results This study did not demonstrate any effect  of acupuncture ( 95 % CI ) compared with st and ard care . The overall vomiting in the acupuncture and usual-care groups was 44.2 % and 47.9 % , respectively . Nausea was experienced by 31.7 % in the acupuncture group and by 32.6 % in the usual-care group . The test power was acceptable for comparisons of vomiting . Conclusions The findings suggest that when controlling for possible placebo effects st and ardised PC6 acupuncture needling during anaesthesia without further stimulation of PC6 is not effective in reducing nausea and vomiting in children after tonsillectomy with or without 
    Output:
    
RESULTS The pain score reported by patients during the first 48 hours and the postoperative need for analgesics were significantly lower in the acupuncture group versus the control group .
Additionally , the incidence of postoperative nausea and vomiting was significantly lower in the acupuncture group than in the control group .
Perioperative acupuncture may provide pain relief without side effects in patients undergoing tonsillectomy .