***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: Anti-inflammatory drugs should impair wound healing , which may explain why they have been used to only a limited extent to relieve pain . If they are to have maximal effect they must be started before the operation . In the present study , single doses of the non-steroidal anti-inflammatory agent diclofenac or of diclofenac and the corticosteroid methylprednisolone were given before operation , and the effects on wound healing after operative extraction of third molars were recorded . Patients developed 18 postoperative complications ( 5 % ) , the most common of which was alveolar osteitis ( n = 14 ) , followed by bleeding ( n = 3 ) and infection ( n = 1 ) . Pretreatment with diclofenac alone or in combination with methylprednisolone did not result in a notable increase in the incidence of complications as compared to placebo BACKGROUND Rofecoxib is a selective cyclooxygenase-2 inhibitor indicated for the treatment of acute pain , with similar analgesic efficacy to ibuprofen and naproxen sodium . Diclofenac sodium is the most commonly prescribed nonsteroidal anti-inflammatory drug worldwide ; it is effective for the treatment of pain as well as the signs and symptoms associated with the painful conditions of osteoarthritis and rheumatoid arthritis . OBJECTIVE The aim of this study was to compare the analgesic efficacy and tolerability of a single dose of rofecoxib 50 mg , 3 doses of enteric-coated diclofenac sodium 50 mg , and placebo over 8-hour and 24-hour periods in patients with moderate to severe pain after oral surgery . METHODS In this double-blind , placebo- and active comparator-controlled , parallel-group study , patients experiencing moderate to severe pain after the surgical extraction of > or = 2 third molars were r and omized to receive a single dose of rofecoxib 50 mg , 3 doses of enteric-coated diclofenac sodium 50 mg ( 50 mg given every 8 hours ) , or placebo . Patients rated pain intensity , pain relief , and global assessment s at prespecified times throughout the 24-hour period after initial dosing . Overall analgesic efficacy was determined by total pain relief over 8 hours ( TOPAR8 ) and 24 hours ( TOPAR24 ) and patient global assessment s at 8 and 24 hours . Onset of analgesic effect was determined by using the 2-stopwatch method for confirmed perceptible pain relief . Peak analgesic effect was the maximum pain relief attained during the first 8 hours . The duration of analgesic effect was determined by median time to rescue analgesia use . RESULTS A total of 305 patients were r and omized to treatment : 121 received rofecoxib , 121 received diclofenac sodium , and 63 received placebo . The baseline demographics were similar among the groups . Overall , 61.3 % experienced moderate pain and 38.7 % experienced severe pain ; 53.1 % were female ; and the mean age was 23.4 years . The overall analgesic efficacy , as assessed by TOPAR8 , of a single dose of rofecoxib 50 mg was significantly greater than a single dose of enteric-coated diclofenac sodium 50 mg ( 20.5 vs 8.2 ) and placebo ( 20.5 vs 5.9 ) . Patient global assessment at 8 hours was also significantly better for rofecoxib compared with enteric-coated diclofenac sodium and placebo . TOPAR24 was significantly greater for a single dose of rofecoxib 50 mg compared with 3 doses of enteric-coated diclofenac sodium 50 mg ( 64.1 vs 25.1 ) and placebo ( 64.1 vs 19.2 ) . At 24 hours , the patient global assessment for rofecoxib was significantly better than that achieved with enteric-coated diclofenac sodium and placebo . The onset of analgesic effect was significantly more rapid for rofecoxib than for enteric-coated diclofenac sodium and placebo ( median times : 31 minutes , > 4 hours , and > 4 hours , respectively ) . The peak analgesic effect was significantly greater for rofecoxib compared with enteric-coated diclofenac sodium ( 3.2 vs 1.5 ) and placebo ( 3.2 vs 1.1 ) . The duration of analgesia was significantly longer for rofecoxib than enteric-coated diclofenac sodium ( median times : > 24 hours vs 1 hour and 37 minutes ) and placebo ( > 24 hours vs 1 hour and 37 minutes ) . Enteric-coated diclofenac sodium was numerically greater than placebo for the key end points measuring overall efficacy ( total pain relief and patient global assessment ) , but diclofenac sodium did not provide as much analgesic effect as expected for a drug effective for pain , osteoarthritis , and rheumatoid arthritis and did not differ significantly from placebo . Overall , both rofecoxib and enteric-coated diclofenac sodium were generally well tolerated , although the rofecoxib group had a significantly lower incidence of clinical and drug-related adverse events than the enteric-coated diclofenac sodium group . CONCLUSIONS A single 50-mg dose of rofecoxib provided greater overall analgesic efficacy over 8 hours , more rapid onset of analgesia , greater maximum analgesic effect , and longer duration of effect than a single 50-mg dose of enteric-coated diclofenac sodium in patients with moderate to severe pain associated with oral surgery . Compared with 3 doses of enteric-coated diclofenac sodium 50 mg ( 50 mg every 8 hours ) , a single dose of rofecoxib 50 mg provided greater overall analgesic efficacy over 24 hours Pre-emptive analgesic efficacy of the non-steroidal anti-inflammatory drug , diclofenac sodium , was tested in 21 young , fit , patients undergoing third molar extraction s in a double-blind , r and omised , cross-over , trial . Pain scores and mouth opening were observed for 1 week after the operation and these did not show any differences following pre- and postoperative oral administration of diclofenac sodium 100 mg ( P > 0.05 ) . There were no differences in the patients ' preference for the two methods of treatment ( P > 0.05 ) . The study suggests that the non-steroidal anti-inflammatory drug diclofenac sodium does not cause any significant pre-emptive analgesic effects in the dose administered A controlled , parallel group study of the analgesic efficacy of flupirtine maleate , was compared against diclofenac sodium in 40 orthopaedic patients with post-operative pain . Clinical ly , both drugs were of equal analgesic efficacy . A mathematical model has been developed , however , to evaluate the speed , intensity and duration of the analgesic effect and provides data which significantly favour flupirtine maleate in the treatment of these patients The efficacy of diclofenac sodium ( Voltarol ) with and without paracetamol in the control of post-surgical dental BACKGROUND & AIMS Epidemiologic data indicate that the risk of nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal ( GI ) clinical events varies based on patients ' clinical characteristics . The authors determined risk factors for NSAID-related clinical upper GI events and the event rates , absolute risk reductions , and numbers needed to treat for individual risk factors for a nonselective NSAID and a selective cyclooxygenase 2 inhibitor in a double-blind outcomes trial . METHODS Eight thous and seventy-six rheumatoid arthritis patients aged > or=50 years ( or > or=40 on corticosteroid therapy ) were r and omly assigned to rofecoxib 50 mg daily or naproxen 500 mg twice daily for a median of 9 months . The development of clinical upper GI events ( bleeding , perforation , obstruction , and symptomatic ulcer identified on clinical ly indicated work-up ) was assessed . RESULTS Significant risk factors included prior upper GI events , age > or=65 , and severe rheumatoid arthritis ( RR , 2.3 - 3.9 ) . Patients administered naproxen who had prior upper GI complications or who were aged > or=75 years had 18.84 or 14.46 events per 100 patient-years , and the risk of events remained constant over time . The reduction in events with rofecoxib was similar in high- and low-risk subgroups ( RR , 0.31 - 0.68 ) . The number needed to treat with rofecoxib instead of naproxen to avert 1 GI event was 10 - 12 in highest risk patients ( prior event , age > or=75 years , or severe rheumatoid arthritis ) , 17 - 33 in patients with other risk factors , and 42 - 106 in low-risk patients . CONCLUSIONS NSAID-related GI events increase dramatically with risk factors such as prior events or older age . Ten to twelve high-risk patients need to be treated with a protective strategy such as the selective cyclooxygenase 2 inhibitor , rofecoxib , to avert a clinical GI event In a controlled trial , before having a lower wisdom tooth surgically removed , 190 patients were blindly r and omized to 2 parallel groups . One group received 100 mg Voltaren ( diclofenac-sodium ) before surgery and then 50 mg 3 times a day for 5 days ; the other group in Sweden widely used fixed combination tablets ( acetylsalicylic acid 500 mg , caffeine 50 mg , aprobarbital 20 mg , codeine phosphate 10 mg ) in the highest recommended dose , 2 tablets when needed at most 3 times a day . Twice a day the patients recorded pain and swelling on 100 mm visual analogue scales . Patients treated with Voltaren had significantly less pain and swelling ( p less than 0.001 ) . Furthermore , they had significantly fewer days away from work ( p less than 0.01 ) . The study indicates that visual analogue scales may also be useful in assessment of swelling and that Voltaren in a fixed dosage offers a promising alternative against postoperative pain and swelling 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 BACKGROUND Ketorolac is approved for the relief of postoperative pain but concerns have been raised over a possible risk of serious adverse effects and death . Two regulatory review s in Europe on the safety of ketorolac found the data were inconclusive and lacked comparison with other non-steroidal anti-inflammatory drugs . The aim of this study was to compare the risk of serious adverse effects with ketorolac vs diclofenac or ketoprofen in adult patients after elective major surgery . METHODS This prospect i ve , r and omized multicentre trial evaluated the risks of death , increased surgical site bleeding , gastrointestinal bleeding , acute renal failure , and allergic reactions , with ketorolac vs diclofenac or ketoprofen administered according to their approved parenteral and oral dose and duration of treatment . Patients were followed for 30 days after surgery . RESULTS A total of 11,245 patients completed the trial at 49 European hospitals . Of these , 5634 patients received ketorolac and 5611 patients received one of the comparators . 155 patients ( 1.38 % ) had a serious adverse outcome , with 19 deaths ( 0 . 17 % ) , 117 patients with surgical site bleeding ( 1.04 % ) , 12 patients with allergic reactions ( 0.12 % ) , 10 patients with acute renal failure ( 0.09 % ) , and four patients with gastrointestinal bleeding ( 0.04 % ) . There were no differences between ketorolac and ketoprofen or diclofenac . Postoperative anticoagulants increased the risk of surgical site bleeding equally with ketorolac ( 
    Output:
    
Though higher doses produced lower ( better ) NNTs , statistical significance was not achieved .
REVIEW ERS ' CONCLUSIONS Oral diclofenac is an effective single-dose treatment for moderate to severe postoperative pain .