***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: Summary In a bid to minimise dosage and possible side-effects when relieving post episiotomy pain , the NSAID Indomethacin was studied in combination with a systemic haemostat Ethamsylate which has been shown to selectively inhibit some prostagl and ins . Comparative groups also took Indomethacin alone and placebo in a double blind non-crossover comparison . Efficacy was judged in terms of side-effects and assessment s of pain intensity , pain relief and global assessment of pain . There was some evidence of a beneficial interaction between Indomethacin and Ethamsylate when adjustments were made for the patient ’s age and initial pain score .  Side-effects were most common in the combination therapy group Meclofenamate sodium , a nonsteroidal anti-inflammatory drug with proven analgesic effects , was compared at two dose levels ( 200 mg and 100 mg ) with codeine ( 60 mg ) and placebo in a double-blind , r and omized study of 327 women experiencing episiotomy pain after normal delivery .  Meclofenamate sodium at either dose was significantly better than codeine or placebo in reducing pain intensity and increasing pain relief , and it had a longer duration of action . Adverse effects were minimal , and their frequency did not differ significantly among treatment groups . Meclofenamate sodium appears to be as safe as and more effective than codeine for the management of episiotomy pain One hundred and ten patients who had episiotomies to aid normal vaginal delivery without epidural analgesia were = allocated at r and om to receive either diclofenac ( n = 56 ) or = placebo ( n = 54 ) suppositories . Pain after episiotomy was assessed at 24 and 48 hours using a combination of a visual analogue scale , a modified pain score and a review of additional analgesia required . All patients in both groups were allowed routine hospital analgesia on request . Our data suggests that very few patients suffered severe pain , even in the placebo group . However , the prophylactic use of diclofenac suppositories significantly reduced perineal pain in the first 24 hours , although the difference was less marked by 48 hours . Overall additional analgesia requirement was correspondingly less in the diclofenac group Objective To determine if diclofenac suppositories administered prophylactically produce effective A double-blind , placebo-controlled trial was carried out in 299 patients suffering from post-episiotomy pain to compare the analgesic effectiveness and tolerance of single doses of 500 mg dipyrone and 500 mg paracetamol . Assessment s of pain relief over a 6-hour period showed that dipyrone produced significantly better results than placebo within half an hour of intake and maintained this superiority throughout the 6 hours . It also afforded consistently better pain relief than paracetamol and was significantly more effective at the 6-hour assessment . Side-effects were few and mild 1 In a double-blind study , 108 postpartum patients received single oral doses of either placebo , acetaminophen ( paracetamol ) 1000 mg , hydrocodone 10 mg , the combination of acetaminophen plus hydrocodone , or codeine 60 mg . 2 In the 2X2 factorial analysis , both the acetaminophen and hydrocodone effects were statistically significant , whereas the interaction contrast was not . This indicates that the analgesic effect of the combination represents the additive effect of its constituents and is consistent with the assumption that these constituents are producing analgesia by different mechanisms . 3 Although significantly superior to placebo , codeine seemed to be inferior to the other treatments . 4 Compared with placebo , both codeine and hydrocodone ( central ly acting narcotics ) seemed relatively more effective in uterine cramp than episiotomy pain ; the reverse seemed true with acetaminophen ( a peripherally acting analgesic ) . 5 Some method ological implication s for the evaluation of analgesic combinations are discussed OBJECTIVES To evaluate efficacy of ibuprofen compared with acetaminophen for relief of perineal pain after childbirth , side effects of ibuprofen compared with acetaminophen and patient satisfaction in treatment between the 2 groups . MATERIAL AND METHOD A total of 210 women who gave birth by spontaneous vaginal delivery with mediolateral episiotomy between June 2006 and November 2006 were r and omly assigned to receive either ibuprofen ( 400 mg ) ( n = 106 ) or acetaminophen ( 1000 mg ) ( n = 104 ) , both given orally when suturing was completed . Pain ratings were recorded before the treatment and at 1 , 2 , 3 and 4 hours after the treatment on a 10-cm visual analogue scale . Side effects and patient satisfaction were assessed at 24 hours . RESULTS Pain in the ibuprofen group was considerably more reduced than the acetaminophen group at 1 hour of treatment ( mean pain rating 2.18 vs. 2.88 , respectively ; p < 0.003 ) . Even though , at 2 , 3 and 4 hours of treatment ibuprofen seemed to give more reliefof pain than acetaminophen , they did not reach statistically significant differences ( mean pain rating ; at 2 hour : 1.59 vs. 1.97 , p = 0.093 ; at 3 hour : 1.08 vs. 1.31 , p = 0.183 ; and at 4 hour : 0.69 vs. 0.85 , p = 0.169 ; respectively ) . There were no side effects and no significant differences in overall patient satisfaction between the two groups . CONCLUSION Ibuprofen was consistently better than acetaminophen at 1 hour after treatment for relief of perineal pain after childbirth without any side effects . After 2 hours , ibuprofen and acetaminophen had similar analgesic properties Our purpose was to evaluate the analgesic efficacy of single oral doses of ketoprofen 25 , 50 , and 100 mg compared with aspirin 650 mg and placebo in the relief of moderate to severe postepisiotomy , uterine cramping , or cesarean section pain . One hundred and fifty-six patients participated in a r and omized , double-blind , stratified , parallel-group study . They were observed over a six-hour period by one nurse-observer . Several of the st and ard summary measures of analgesia were derived from the interview data , including the sum of pain intensity differences ( SPID ) and the sum of the hourly relief values ( TOTAL ) . The study showed significant differences between aspirin and placebo for four-hour SPID and several other parameters and between ketoprofen at all dose levels and placebo for the four- and six-hour SPID and many other parameters . The two higher doses of ketoprofen were significantly more effective than aspirin as as assessed by the four- and six-hour SPID , TOTAL , and other summary measures . The low dose of ketoprofen , although not significantly different from aspirin for SPID and TOTAL , showed a significantly faster onset of relief and had a better global rating . This study suggests that 50 mg of ketoprofen may be the clinical dose of choice as an analgesic . There were no adverse effects reported The analgesic activity of 300 and 600 mg . of flufenisal , a fluorinated phenyl derivative of aspirin , was compared to 600 and 1,200 mg . of aspirin and to placebo under r and omized double‐blind conditions in 100 patients with pain due to episiotomy . Over the 8 hours of evaluation , pain reduction greater than 50 per cent was observed in at least 60 per cent of patients treated with both doses of flufenisal , whereas it was 40 per cent with 600 mg . of aspirin , 55 per cent with 1,200 mg . of aspirin , and 26 per cent with placebo . On a time‐effect basis with the two grade d doses of both flufenisal and aspirin  , pain relief , as measured by pain intensity differences , was similar with respect to time of onset and maximal effect attained . However , with the flufenisal  significant analgesia persisted at the eighth hour ( p < 0.02 ) , while with the aspirin there was none after the fifth hour . On the basis of these data , flufenisal at one fourth to one half the dose of aspirin appears to provide analgesia of almost double the duration of aspirin and is equivalent to aspirin  in time of onset and degree of relief of episiotomy pain . This raises the possibility that in some clinical conditions flufenisal may be effective in providing prolonged pain relief A double-blind , r and omised placebo-controlled study was carried out to assess the efficacy of indometacin suppositories as a post-episiotomy analgesic . Thirty patients received 2 X 100 mg indometacin suppositories  , and 30 patients received  placebo suppositories within 15 min of an episiotomy repair operation . Local infiltration of the episiotomy incision was performed using 20 ml of 0.5 % lignocaine in every case . Subjective symptoms of pain were evaluated 15 , 30 , 60 and 90 min post-episiotomy repair . Average numbers of hours as lying in patients after delivery is 4 h. None of the patients who received  indometacin complained of post-episiotomy pain ; whereas the patients on placebo manifested varying degrees of pain In a clinical trial conducted on women suffering from postpartum pain , 600 mg of acetaminophen proved as effective an analgesic as similar doses of acetophenetidin or acetylsalicylic acid . A new statistical technique for analyzing analgesic response is described 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 Pain from episiotomy or tearing of perineal tissues during childbirth is often poorly treated and may be severe . This r and omized double-blind controlled trial was performed to compare the effectiveness , side effects and cost of , and patient preference for , 2 analgesics for the management of  postpartum perineal pain . METHODS A total of 237 women who gave birth vaginally with episiotomy or a third- or fourth-degree tear between August 1995 and November 1996 at a tertiary-level teaching and referral centre for obstetric care in Vancouver were r and omly assigned to receive either ibuprofen ( 400 mg ) ( n = 127 ) or acetaminophen ( 600 mg ) with codeine ( 60 mg ) and caffeine ( 15 mg ) ( Tylenol No. 3 ) ( n = 110 ) , both given orally every 4 hours as necessary . Pain ratings were recorded before the first dose and at 1 , 2 , 3 , 4 , 12 and 24 hours after the first dose on a 10-cm visual analogue scale . Side effects and overall opinion were assessed at 24 hours . RESULTS Ibuprofen and acetaminophen with codeine had similar analgesic properties in the first 24 hours post partum ( mean pain rating 3.4 and 3.3 , mean number of doses in 24 hours 3.4 and 3.3 , and proportion of treatment failures 13.8 % [ 16/116 ] and 16.0 % [ 16/100 ] respectively ) . Significantly fewer subjects in the ibuprofen group than in the acetaminophen with codeine group experienced side effects ( 52.4 % v. 71.7 % ) ( p = 0.006 ) . There were no significant differences in overall patient satisfaction between the 2 groups . The major determinant of pain intensity was forceps-assisted delivery . Overall , 78 % of the treatment failures were in women with forceps-assisted deliveries . INTERPRETATION Since the 2 analgesics were rated similarly , ibuprofen may be the preferred choice because it is less expensive and requires less nursing time to dispense . Further studies need to address improved analgesia for women with forceps-assisted deliveries Local infiltration is seldom used during episiotomy repairs in patients who have been delivered under an effective epidural block and increased  post‐episiotomy  pain has been found in association with epidural analgesia . The hypothesis that this leads to tight wound closure and thereby causes increased perineal pain was examined in a double‐blind r and omized trial in patients who had normal 
    Output:
    
Both the 500 mg to 650 mg and 1000 mg doses were effective in providing more pain relief than placebo .