***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: Purpose : Non-steroidal anti-inflammatory drugs ( NSAIDs ) are used as analgesic in postoperative pain to reduce opioid side effects , such as drowsiness and nausea . However , NSAIDs have not been used extensively in cardiac surgical patients due to the fear of untoward effects on gastric , renal , and coagulation parameters . This study will evaluate the efficacy and safety of three NSAIDs for pain control in CABG patients . Methods : One hundred and twenty patients scheduled for elective CABG surgery were enrolled in r and omized , double blind , controlled study . St and ardized fast track cardiac anesthesia was used . One dose of drug ( 75 mg diclofenac , 100 mg ketoprofen , 100 mg indomethacin , or placebo ) was givenpr one hour before tracheal extubation and a second dose 12 hr later . Pain was treated with morphineiv and acetaminophenpo .  Visual analogue pain scores were recorded at baseline , 3 , 6 , 12 and 24 hr after the first dose of drug . Results : There were no differences among the groups in pain scores . Only patients who received diclofenac required less morphine than patients in the control group ( P<0.05 ) . When the total amounts of pain medications were computed to morphine equivalents , only patients in the diclofenac group received less pain medications than the placebo group ( P<0.05 ) . Proportion of patients with postoperative increase of creatinine level ( 20 % and over ) did not differ between placebo and drug groups . Conclusion : Non-steroidal anti-inflammatory drugs may be used for anaalgesia management post CABG surgery in selected patients .  Diclofenac appears to have the best analgesic effects by reducing the morphine and other analgesic requirement postoperatively . RésuméObjectif : Les anti-inflammatoires non stéroïdiens ( AINS ) servent d’analgésique postopératoire et réduisent les effets secondaires des opioïdes , comme la somnolence et les nausées . Leur emploi en cardiochirurgie est plutôt restreint où on craint des effets gastriques et rénaux indésirables et des modifications de la coagulation . On a voulu évaluer l’efficacité et la sécurité d’emploi analgésique de trois AINS chez des patients qui subissent un pontage aortocoronarien . Méthode : L’étude r and omisée , contrôlée et à double insu a porté sur 120 patients qui devaient subir un pontage aortocoronarien . Une anesthésie cardiaque normalisée pour un séjour hospitalier écourté a été utilisée . Une dose de médicament ( 75 mg de diclofénac , 100 mg de kétoprofène , 100 mg d’indométhacine , ou un placebo ) a été administréepr une heure avant l’extubation endotrachéale et une seconde dose 12 h plus tard . La douleur a été traitée avec de la morphineiv et de l’acétaminophènepo . Les scores de douleur ont été enregistrés à l’échelle visuelle analogique au début , puis 3 , 6 , 12 et 24 h après la première dose de médicament . Résultats : Les scores de douleur n’ont pas présenté de différence intergroupe . Seuls les patients du groupe diclofénac ont dem and é moins de morphine que ceux du groupe témoin ( P<0,05 ) . Lorsque les quantités totales d’analgésiques ont été calculées en équivalents de morphine , seuls les patients du groupe diclofénac avaient reçu moins d’analgésique que les témoins ( P<0,05 ) . La proportion de patients qui présentaient une augmentation postopératoire du niveau de créatinine ( 20 % et plus ) ne différait pas du groupe placebo aux autres groupes . Conclusion : Les anti-inflammatoires non stéroïdiens sont utiles en analgésique postopératoire chez des patients qui subissent un pontage aortocoronarien planifié . Le diclofénac semble offrir la meilleure analgésie en réduisant les besoins de morphine et d’autres analgésiques Under double-blind , crossover conditions , 43 women with primary dysmenorrhea received ketoprofen , ibuprofen , and placebo during three consecutive menstrual cycles .  Pain intensity and pain relief were determined before and for 6 hours after the loading dose ( ketoprofen 150 mg , ibuprofen 800 mg ) and before and 2 hours after the maintenance dose ( ketoprofen 75 mg , ibuprofen 400 mg ) . Mean pain intensity difference and pain relief scores consistently indicated greater pain relief after the loading doses of ketoprofen and ibuprofen than after placebo . Significant ( P less than 0.05 ) mean changes that were measured by 13 indices of analgesia after the loading doses of both ketoprofen and ibuprofen indicated greater efficacy for the active treatments than for placebo . The patients ' global evaluations after the loading doses were significantly ( P less than 0.05 ) better for the active treatments than for placebo . The efficacy results were similar after the maintenance doses . The rates of a " good " to " excellent " response were 77 % for ketoprofen , 73 % for ibuprofen , and 35 % for placebo . Ketoprofen and ibuprofen were equally well tolerated , the most frequent adverse experiences being gastrointestinal symptoms for ketoprofen and central nervous system side effects for ibuprofen A double-blind parallel multi-centre study of 102 patients with rheumatoid arthritis ( RA ) was performed , comparing ibuprofen ( 1200 - 2400 mg daily ) and ketoprofen ( 150 - 300 mg daily ) a new non-steroidal , anti-inflammatory agent , over a three month period . Ketoprofen was well tolerated and shown to have comparable efficacy with ibuprofen .  Longterm efficacy and tolerance studies are indicated In a multi-centre double-blind cross-over trial using the double-placebo technique , 55 patients with rheumatoid arthritis were treated for 10 days for each trial drug with ketoprofen ( 200 mg/day ) and ibuprofen ( 1200 mg/day ) . Both drugs induced a clinical ly and statistically significant improvement of all the symptoms studied , except for pain at night during ibuprofen administration . Ketoprofen displayed a therapeutic efficacy significantly superior to ibuprofen in five of the eight symptoms studied . Side-effects were recorded in 10 patients receiving ketoprofen ( one patient withdrew because of heartburn ) and in nine patients receiving ibuprofen Preoperative treatment with controlled-release ketoprofen or diclofenac was compared in 56 out- patients , for control of postoperative dental pain , following unilateral or bilateral surgical removal of lower third molars . Six patients were excluded due to non-compliance , leaving 50 evaluable patients . Patients were assessed by the dental surgeon , on the day of the operation and one week later , prior to removal of sutures . Additionally , patients completed a daily diary during the postoperative week . Following surgery , scores for grade d dental pain , consumption of paracetamol , incidence of dental bleeding , dysphagia , sleep disturbance and trismus were similar for the two treatment groups . However , median pain scores were consistently elevated in the diclofenac group over those seen with the ketoprofen group . The four adverse events reported were all minor and posed no problem to patient management A double-blind cross-over study of ketoprofen ( Orudis ) 150 mg daily and ibuprofen ( Brufen ) 1,200 mg daily was carried out in 35 out patients with rheumatoid arthritis . Results suggest that analgesic and anti-inflammatory activity of ketoprofen is superior to that of ibuprofen .  Significantly greater pain relief ( P < 0·05 ) and reduction in joint circumference ( P < 0·01 ) was obtained with ketoprofen than with ibuprofen . Side effects of the drugs were comparable and not serious A comparative controlled study was carried out in 40 patients suffering from rheumatoid arthritis , osteoarthrosis or ankylosing spondylitis to assess the efficacy of ketoprofen and ibuprofen . Patients were allocated at r and om to receive either 100 mg ketoprofen twice daily or 400 mg ibuprofen 3-times daily over a period of 3 months . Subjective overall assessment s of symptoms , based on rating scale scores for pain , duration of morning stiffness and inflammation , showed that there was a greater , more rapid and more sustained improvement in those patients treated with ketoprofen .  Measurements of inflamed joint size and of grip strength also improved more with ketoprofen than with ibuprofen . Side-effects , notably nausea , epigastric discomfort and abdominal pain , were more frequent and severe with ketoprofen , leading to the withdrawal of 2 patients in the early stage of the trial , and were probably related to the high dosage used . Three patients receiving ibuprofen needed 7 injections of ACTH to control their symptoms Eighteen patients with rheumatoid arthritis were treated for 3 months with controlled release ketoprofen ( Oruvail ) 100 mgm once daily ( 9 patients ) or diclofenac sodium ( Voltaren ) 25 mgm three times daily ( 9 patients ) . Patients were evaluated at the start of the study and at subsequent visits on days 28 , 56 and 84 . Clinical evaluation included assessment of severity and duration of morning stiffness and the severity of pain and Joint tenderness . Patients were instructed not to take any other nonsteroidal anti -Inflammatory drug , although paracetamol tablets were provided for pain relief if required . Over the study period patients receiving ketoprofen showed a significant reduction in severity of pain , Joint tenderness and morning stiffness . Patients receiving diclofenac sodium showed a significant decrease only In morning stiffness . No estimation of patient compliance or of consumption of paracetamol  was made during the study . The incidence of side effects was similar with both drugs , and liver function tests , kidney function , electrolytes and haematology were not affected by drug treatment . Six patients withdrew from the study , three from each drug group . Both ketoprofen and diclofenac sodium were concluded to have beneficial therapeutic effects in patients with rheumatoid arthritis when administered at their minimum recommended dose levels Ninety patients with rheumatoid arthritis completed a double-blind crossover trial comparing fenoprofen , ibuprofen , ketoprofen , and naproxen . Fenoprofen and naproxen were slightly more effective than the other two drugs but there were striking individual variations in response . Groups of patients could be identified who preferred each of the four drugs . The commonest side effects were those related to the upper gastrointestinal tract ; these showed individual variation and seldom occurred with more than one or two of the drugs . Side effects were least common with ibuprofen and naproxen . Since naproxen combined greater effectiveness with a lower incidence of side effects it must be regarded as the first choice among these drugs . It may be necessary to try several drugs before finding the right one for a particular patient 
    Output:
    
The results of the meta- analysis showed a statistically significant difference in efficacy in favour of ketoprofen .
Heterogeneity for the analysed efficacy outcome was not statistically significant in any of the meta-analyses .
The efficacy of orally administered ketoprofen in relieving moderate-severe pain and improving functional status and general condition was significantly better than that of ibuprofen and /or diclofenac