***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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    ***EXAMPLES*** 
    Input: The efficiency and safety of postoperative use of propacetamol was estimated in 30 patients by means of double blind placebo controlled method . The first group consisted of 15 patients to whom propacetamol was introduced intravenously in single dose of 2 g along with patient controlled anesthesia with promedol . Placebo in combination with patient control anesthesia were used in 15 patients from the 2nd group . Intravenous introducing of propacetamol in dose of 2 g in 15 minutes provides relief of pain intensity in postoperative period . So it permits to consider propacetamol as basic non-opioid analgesic . In early postoperative period combination of propacetamol and opioid analgesic ( promedol )  reduces dem and s in the latter by 44 % BACKGROUND Propacetamol is widely used in the management of postoperative pain .  It decreases morphine requirements but its effect on the incidence of morphine-related adverse effects remains unknown . METHODS Patients ( 550 ) were r and omly assigned to receive propacetamol or a placebo over the first 24 h after operation in a blinded study . Intravenous morphine titration was performed , after which morphine was administered s.c . every 4 h according to their pain score . Pain was assessed using a visual analogue scale ( VAS ) . The primary end-point was the incidence of morphine-related adverse effects . The main secondary end-points were morphine requirements and VAS score . RESULTS After morphine titration , the VAS score and the number of patients with pain relief did not differ between groups . Morphine requirements were decreased in the propacetamol group ( 21 vs 14.5 mg , P<0.001 ) but the incidence of morphine-related adverse effects did not differ between groups ( 42 vs 46 % , not significant ) . In patients with moderate pain ( n=395 ) , morphine requirements decreased by 37 % ( P<0.001 ) and the percentage of patients requiring no morphine was greater ( 21 vs 8 % , P=0.002 ) in the propacetamol group . In patients with severe pain ( n=155 ) , morphine requirements decreased by 18 % ( P=0.04 ) in the propacetamol group and the number of patients who did not require morphine  ( 3 vs 8 % ) did not differ significantly . CONCLUSIONS Although propacetamol induced a small morphine-sparing effect , it did not change the incidence of morphine-related adverse effects in the postoperative period . Moreover , no benefit could be demonstrated in patients with severe postoperative pain In order to compare the morphine‐sparing effect , analgesic efficacy and tolerance of nefopam and propacetamol given at their highest recommended doses , 120 patients undergoing elective hepatic resection were r and omly assigned to receive postoperative intravenous patient‐controlled analgesia with morphine alone , or in combination with nefopam ( 20 mg.4 h‐1 ) or propacetamol ( 2 g.6 h‐1 ) . Compared with the control group ( 43 [ 7–92 ] mg ) , median [ range ] cumulative morphine consumption for 24 h after the study started was halved in the nefopam group ( 21 [ 3–78 ] mg , p < 0.001 ) and 20 % lower in the propacetamol group ( 35 [ 6–84 ] mg , p = 0.15 ) . Analgesia was superior in the nefopam group despite the lower morphine consumption . Adverse effects were comparable in the three groups , except for significantly more nausea in the control group ( 39 % vs. 17 and 26 % in the nefopam and propacetamol groups , respectively ) and more sweating in the nefopam group ( 17 % vs. 0 and 3 % in the control and propacetamol groups , respectively ) . Overall patient satisfaction was better ( p < 0.001 ) in patients given nefopam ( 97 % ) than those receiving morphine alone ( 82 % ) or propacetamol ( 74 % ) 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 We assessed the analgesic efficacy of IV propacetamol and ketorolac in a double-blinded , placebo-controlled study involving patients undergoing total hip or knee replacement procedures . On the first morning after major joint replacement surgery , 164 patients experiencing moderate-to-severe pain were r and omly assigned to receive an IV infusion of propacetamol ( 2 g ) , ketorolac ( 15 or 30 mg ) , or placebo ( saline ) .  Patient-controlled analgesia with morphine was made available as a “ rescue ” analgesic on patient ’s request during the 6-h postdosing evaluation period . The median time to onset of analgesia with propacetamol ( 8 [ 95 % confidence interval 6,10 ] min ) was shorter than ketorolac 15 mg ( 14 [ 7,16 ] min ) , and placebo ( 16 [ 8 ; not estimable ] min ) although the differences did not reach statistical significance . However , compared with ketorolac 30 mg , propacetamol had a shorter duration of analgesia ( 3.5 [ 2;5.4 ] vs 6 [ 3.3 ; not estimable ] h ) . Analysis of pain intensity and pain relief scores demonstrated that propacetamol produced a significantly greater improvement in pain relief than saline from 45 min until 5 h after the injection . Propacetamol was not significantly different from ketorolac 15 mg and 30 mg with respect to the main analgesic efficacy variables during the 6-h assessment period . The most frequently reported adverse event with propacetamol was injection site pain ( 28 % vs 19 % for ketorolac 15 mg , 29 % for ketorolac 30 mg , and 10 % for placebo , respectively ) . In conclusion , propacetamol ( 2 g IV ) possesses a similar analgesic efficacy to ketorolac ( 15 or 30 mg IV ) after total hip or knee replacement surgery We have evaluated the morphine-sparing effect of rectal paracetamol during the first 24 h after abdominal hysterectomy in a placebo-controlled , double-blind study . We studied 72 patients receiving patient-controlled analgesia ( PCA ) with i.v . morphine after a st and ardized anaesthetic , allocated r and omly to receive rectal paracetamol 1.3 g , diclofenac 50 mg or placebo , after wound closure and at 8 and 16 h. Suppositories were blinded by the hospital pharmacy . Study violations excluded data from seven patients .  Patient data , morphine doses during anaesthesia and recovery , and sedation and nausea scores were comparable . Mean morphine consumption during PCA was 35.0 ( SD 20.4 ) mg , 32.7 ( 27.4 ) mg and 54.9 ( 28.3 ) mg in the paracetamol ( n = 24 ) , diclofenac ( n = 20 ) and placebo ( n = 21 ) groups , respectively ( P < 0.05 ) . Morphine sparing during PCA for paracetamol and diclofenac ( 36 % vs 40 % over 24 h ) was significant from 4 h. Global scores of average pain over 24 h were lower after diclofenac compared with paracetamol ( P < 0.01 ) and placebo ( P = 0.08 ) . We conclude that rectal paracetamol was an efficacious adjuvant analgesic after regular dosing UNLABELLED We assessed the relative morphine consumption in a combined analgesic regimen ( on-dem and morphine plus the nonopioids propacetamol or ketorolac )  after gynecologic surgery . Two hundred women r and omly received two i.v . doses of propacetamol 2 g or ketorolac 30 mg in a double-blinded , double-dummy trial . Patients were monitored for 12 h , and the following efficacy variables were assessed : total dose of morphine , pain intensity , and global efficacy . Safety and tolerability were evaluated by the occurrence of adverse events , especially the presence and intensity of gastrointestinal symptoms . Hemostatic variables were measured 30 and 60 min after the first infusion ; arterial blood pressure , heart and respiratory rates , sedation scores , and renal and hepatic function were also assessed . Total morphine requirements were not significantly different between the propacetamol ( 10.6 + /- 4.8 mg ) and ketorolac ( 10.2 + /- 4.4 mg ) groups . The evolution of pain intensity and the global efficacy also showed similar patterns in the two groups : 70.2 % of patients in the propacetamol group rated the efficacy as " good/ excellent " compared with 68.2 % in the ketorolac group . There were no clinical ly significant changes in vital signs or laboratory values and no observed differences between the two groups , although ketorolac slightly , but not significantly , prolonged the bleeding time . Epigastric pain was present in 9 % and 15 % of patients receiving propacetamol and ketorolac , respectively . There were two adverse events in the propacet 
    Output:
    
Acetaminophen administration was not associated with a decrease in the incidence of morphine-related adverse effects or an increase in patient satisfaction .
Adding acetaminophen to PCA was associated with a morphine-sparing effect of 20 % ( mean , -9 mg ; CI -15 to -3 mg ; P=0.003 ) over the first postoperative 24 h. CONCLUSION Acetaminophen combined with PCA morphine induced a significant morphine-sparing effect but did not change the incidence of morphine-related adverse effects in the postoperative period