***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: This study compared preoperative administration of acetaminophen or a combination of acetaminophen and ibuprofen versus placebo for potential increased effectiveness of inferior alveolar nerve ( IAN ) block anesthesia . There were 40 patients with irreversible pulpitis r and omly assigned to a drug or placebo group . Thirty minutes after ingestion of medication , an IAN block was administered . A cold test was done 15 minutes after the block , and if the patients had no sensitivity , endodontic therapy was initiated . If the patient had no pain on access , the IAN was recorded as successful . If the patient had sensitivity to cold or to the access procedure , it was recorded as a failure . Overall success was 60 % for all three groups . Success was 71.4 % for the acetaminophen group , 75.9 % for the acetaminophen and ibuprofen group , and 46.2 % for the placebo group . There was no significant difference between the groups ; however , there was a trend toward higher success in the medication groups Background . Recently ibuprofen has been introduced as a nonprescription analgesic/antipyretic for use in children . Objective . To compare the incidence of serious adverse clinical events among children < 2 years old given ibuprofen and acetaminophen to control fever . Study Design . A practitioner-based , r and omized clinical trial . A total of 27 065 febrile children were r and omized to receive acetaminophen ( 12 mg/kg ) , ibuprofen ( 5 mg/kg ) , or ibuprofen ( 10 mg/kg ) . Rates of hospitalization for acute gastrointestinal bleeding , acute renal failure , anaphylaxis , Reye 's syndrome , asthma , bronchiolitis , and vomiting/gastritis were compared by r and omization group . Results . The risk of hospitalization with any diagnosis in the 4 weeks after enrollment was 1.4 % ( 95 % confidence interval , 1.3%–1.6 % ) and did not vary by antipyretic assignment . No children were hospitalized for acute renal failure , anaphylaxis , or Reye 's syndrome . Three children were hospitalized with gastrointestinal bleeding ; all 3 had been assigned to treatment with ibuprofen . The risk of hospitalization with gastrointestinal bleeding among children r and omized to ibuprofen was 17 per 100 000 ( 95 % confidence interval , 3.5–49 per 100 000 ) but was not significantly greater than the risk among children given acetaminophen . The risk of hospitalization with asthma , bronchiolitis , or vomiting/gastritis did not differ by antipyretic assignment . Conclusions . The risk of serious adverse clinical events among children < 2 years old receiving short-term treatment with either acetaminophen or ibuprofen suspension was small and did not vary by choice of medication . These data do not provide any information on the safety of these medications when used for prolonged periods or when used together , regardless of duration In a double-blind study of 18 patients with coxarthrosis the effect of 3 naproxen doses ( 0.5 , 1.0 , and 1.5 g daily ) and 2 naproxen doses combined with paracetamol ( 0.5 g + 4 g daily and 1.0 g + 4 g daily ) was investigated . Plasma levels of naproxen and paracetamol  were measured ( HPLC ) , and clinical assessment of pain , joint movement , activity of daily life and side-effects were performed at the end of the 5 treatment periods . A relationship was found between the 3 naproxen doses ,  naproxen plasma levels , pain at rest , and pain during movement . The combined treatment was more effective than treatment with the same naproxen dose alone . The effect of naproxen ( 0.5 g daily ) combined with paracetamol ( 4 g daily ) did not differ from that obtained during treatment with higher naproxen doses only . Furthermore , the effect of the highest naproxen dose was not better than the effect of the lower naproxen dose ( 1.0 g daily ) combined with paracetamol . The main finding was that treatment with  naproxen and paracetamol  is more effective than treatment with higher naproxen doses alone Purpose The concept of balanced analgesia suggests that a combination of analgesic drugs may enhance analgesia and reduce side effects after surgery . This study evaluated the effect of the combination of propacetamol ( Prodafalgan ) and ketoprofen ( Profenid )  after surgery of a hemiated disc of the lumbar spine . Methods After r and omization . 60 patients received : placebo ( group 1 ) ; 2 g propacetamol ( group 2 ) ; 50 mg ketoprofen ( group 3 ) ; or a combination of 2 g propacetamol and 50 mg ketoprofen ( group 4 ) . Drugs were administered every six hours for two days after surgery . The patients used morphine with patient controlled analgesia pumps ( bolus 1 mg ; lock out time 10 min ) and were evaluated with a visual analogue scale ( VAS ) at rest and movement every six hours for two days . Side effects were noted . Results The patient characteristics and surgery were identical for each of the four groups . The VAS scores throughout the study were lower in group 4 than in groups 1 , 2 and 3 both at rest ( P < 0.05 ) and on movement ( P < 0.01 ) . The cumulative dose of morphine at 48 hr was lower in group 4 than in group 1 ( 23.4 ± 5 mg vs 58.9 ± 9 mg ; P < 0.01 ) or group 2 ( 23.4 ± 5 mg vs 43.4 ± 6.6 mg ; P < 0.05 ) and similar to that in group 3 ( 34.2 ± 4.5 mg ) . The incidence of side effects was similar in all groups . Conclusion The combination of propacetamol and ketoprofen  reduced pain scores both at rest and on movement . The drug combination did not reduce the morphine consumption and incidence of side effects . RésuméButLe concept d’analgésie balancée suggère que I’association de drogues analgésiques en postopératoire peut permettre d’améliorer I’analgésie et réduire les effets secondaires . Cette étude a évalué I’intérêt d’une association de propacetamol ( Prodafalgan ) et de ketoprofen ( Profenid ) pour I’analgésie après chirurgie d’une hernie discale lombaire . MéthodesAprès r and omisation 60 patients ont reçu : un placebo ( groupe 1 ) ; 2 g de propacetamol ( groupe 2 ) ; 50 mg de ketoprofen ( groupe 3 ) ; où I’association de 2 g de propacetamol et 50 mg de ketoprofen ( groupe 4 ) . Les produits analgésiques ont été administrés toutes les six heures pendant 48 h. Les patients utilisaient de la morphine grâce à une pompe d’analgésie autocontrôlée pendant 48 h ( bolus 1 mg ; période réfractaire 10 mm ) et la douleur était évaluée par échelle visuelle analogique toutes les six heures au repos et au mouvement . Les effets secondaires étaient notés toutes les six heures . Result atsLes patients et la chirurgie étaient similaires dans les quatre groupes . Les scores d’EVA etaient plus bas pendant les 48 heures de I’étude dans le groupe 4 par rapport à ceux des groupes 1 , 2 et 3 au repos ( P < 0.05 ) comme au mouvement ( P < 0.01 ) . Les doses cumulées de morphine étaient significativement plus basses à 48 h dans le groupe 4 par rapport au groupe 1 ( 23.4 ± 5 mg vs 58.9 ± 9 mg ; P < 0.01 ) . groupe 2 ( 23.4 ± 5 mgvs 43.4 ± 6.6 mg ; P < 0.05 ) et pas significativement différentes de celles du groupe 3 ( 34.2 ± 4.5 mg ) . L’incidence des effets secondaires était similaire dans tous les groupes . Conclusion L’association de propacetamol et ketoprofen a réduit les scores de douleur au repos et au mouvement par rapport aux groupes traités par une seule drogue analgésique . Lassociation propacetamol-ketoprofen n’a pas significativement réduit la consommation de morphine et les effets secondaires Iiés à la morphine Analgesic acetaminophen plasma concentrations are not known . We investigated in a r and omized , double-blinded study the pharmacokinetics and analgesic efficacy of small- ( AS ; 20 mg · kg−1 ) and larger- ( AL ; 40 mg/kg ) dose rectal acetaminophen and compared it with the combination ( C ) of rectal diclofenac ( 100 mg ) and acetaminophen ( 20 mg/kg ) in 65 women undergoing hysterectomy .  Suppositories were administered after the induction of a st and ardized general anesthesia . Pain ( measured by using a 10-cm visual analog scale ) and morphine consumption ( patient-controlled analgesia ) were repeatedly assessed for 24 h.  Acetaminophen plasma concentrations were measured by using a fluorescence polarization immunoassay . Antipyretic plasma concentrations ( 10–20 mg/L ) after 40 mg/kg acetaminophen were not associated with improved analgesia or decreased opioid requirements ; 20 mg/kg acetaminophen produced subtherapeutic plasma levels ( < 10 mg/L ) . Maximal plasma concentrations of 17.2 and 10.4 mg/L ( P < 0.01 , analysis of variance ) were achieved after 4.2 and 3.6 h for the AL and AS groups , respectively . The only difference in clinical outcome was lower visual analog scale scores after acetaminophen/diclofenac  ( C 2.0 versus AS 3.2 and AL 3.4 ) 4 h after the induction ( P < 0.05 , analysis of variance ) . Acetaminophen pharmacokinetics in adults were similar to those observed in children . Analgesic plasma concentrations are likely to be higher than antipyretic plasma levels , which were only attained after twice the recommended rectal dose was administered . Analgesic plasma concentrations have yet to be determined but may be higher than those associated with antipyresis . Implication  s Acetaminophen pharmacokinetics were comparable in adults and children . Plasma concentrations known to reduce fever did not produce better pain relief and were only achieved after twice the conventional dose was administered . Analgesic plasma concentrations have yet to be determined but may be higher than those associated with antipyresis Renal prostagl and in inhibition by nonsteroidal antiinflammatory drugs ( NSAIDs ) may decrease renal function , especially under conditions of low effective circulating volume . To evaluate the risk of important deterioration of renal function due to this effect , the authors performed a nested case-control study using Tennessee Medicaid enrollees aged > or = 65 years in 1987 - 1991 . Cases were patients who had been hospitalized with community-acquired acute renal failure ; they were selected on the basis of medical record review of Medicaid enrollees with selected discharge diagnoses . Information on the timing , duration , and dose of prescription NSAIDs used , demographic factors , and comorbidity was gathered from computerized Medicaid-Medicare data files . Of the 1,799 patients with acute renal failure ( 4.51 hospitalizations per 1,000 person-years ) , 18.1 % were current users of prescription NSAIDs  as compared with 11.3 % of 9,899 r and omly selected population controls . After control for demographic factors and comorbidity , use of NSAIDs increased the risk of acute renal failure 58 % ( adjusted odds ratio = 1.58 ; 95 % confidence interval ( CI ) : 1.34 , 1.86 ) . For ibuprofen , which accounted for 35 % of NSAID use , odds ratios associated with dosages of < or = 1,200 mg/day , > 1,200-<2,400 mg/day , and > or = 2,400 mg/day were 0.94 ( 95 % CI : 0.58 , 1.51 ) , 1.89 ( 95 % CI : 1.34 , 2.67 ) , and 2.32 ( 95 % CI : 1.45 , 3.71 ) , respectively ( test for linear trend : p = 0.009 ) . Prescription NSAID use result ed in an estimated 25 excess hospitalizations associated with renal failure per 10,000 years of use . Thus , NSAIDs represent a relatively uncommon but avoidable cause of acute renal failure in frail elderly persons & NA ; There is uncertainty over whether the patient group in which acute pain studies are conducted ( pain model ) has any influence on the estimate of analgesic efficacy . Data from four recently up date d systematic review s of aspirin 600/650 mg , paracetamol 600/650 mg , paracetamol 1000 mg and ibuprofen 400 mg were used to investigate the influence of pain model . Area under the pain relief versus time curve equivalent to at least 50 % maximum pain relief over 6 h was used 
    Output:
    
: Current evidence suggests that a combination of paracetamol and an NSAID may offer superior analgesia compared with either drug alone