***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: BACKGROUND In this prospect i ve r and omized double-blind study , we compared the incidence of emesis and 48-h recovery profiles after a single dose of ketorolac vs fentanyl in dexamethasone-pretreated children undergoing ambulatory adenoidectomy and laser-assisted tonsillectomy ( ADLAT ) .  We evaluated the hypothesis that avoiding the use of opioids and replacing them with an equianalgesic dose of ketorolac , a nonsteroidal anti-inflammatory drug , would reduce the incidence of postoperative nausea and vomiting ( PONV ) . METHODS Fifty-seven ASA I and II children aged 1.710 years who underwent ADLAT were r and omized to receive either intravenous ketorolac ( 1 mg.kg(-1 ) ) or fentanyl ( 2 microg.kg(-1 ) ) for pain control during a st and ardized general anaesthetic with propofol infusion . The early ( postanaesthesia care unit , day surgical area ) and late postoperative courses were compared between the groups . RESULTS The incidence of PONV was low and equal in both groups . Postoperative pain scores were equal at all stages of followup . Agitation scores in the postanaesthesia care unit were significantly higher in the ketorolac group , but this had no effect on the late variables of behaviour studied . CONCLUSIONS Ketorolac showed no advantage over fentanyl in reducing the incidence of PONV in children undergoing ADLAT Investigators from Bristol described a fentanyl‐ and diclofenac‐based analgesic technique for  tonsillectomy with low postoperative nausea and vomiting rates and low pain scores . This study compared the effectiveness of a modified Bristol technique with a codeine‐based regimen with respect to PONV and analgesia . Sixty‐five children , ASA 1‐2 , were r and omly assigned to either the Bristol group ( fentanyl 1–2 μg.kg−1 and diclofenac 1–2 mg.kg−1 ) or codeine group ( codeine 1.5 mg.kg−1 ) . All children received paracetamol 15 mg.kg−1 and dexamethasone 0.1 mg.kg−1 . Postoperative nausea and vomiting and pain scores were recorded hourly , and fitness for discharge was assessed at 4 h. The overall incidence of postoperative nausea and vomiting was 21 % with no difference between groups ( Bristol group 8/30 , codeine group 5/32 , p = 0.29 ) . Children in the Bristol group required analgesia earlier than those in the codeine group ( p < 0.005 ) , but maximum pain scores were not different ( Bristol group median ( IQR [ range ) 4.5 ( 3‐5 [ 0‐5 ] ) , codeine group 4.0 ( 2‐5 [ 1‐5 ] ) , p = 0.15 ) . Twenty‐three per cent of children were assessed as not fit for discharge at 4 h. The codeine‐based regimen may have a small advantage over the Bristol regimen , but neither technique seems ideally suited for a day‐case service without a longer period of observation & NA ; The efficacy of ketorolac , a non‐steroidal anti‐inflammatory drug , in the management of moderate to severe pain in adults , has led us to conduct a trial of this analgesic in children following tonsillectomy . Children were r and omized to receive intramuscular ( i.m . ) ketorolac ( 1 mg/kg , EXP group , n = 45 ) or saline ( CTL group , n = 42 ) at the completion of surgery . Intravenous ( i.v . ) fentanyl ( 0.5 & mgr;g/kg/dose ) was administered in repeated doses postoperatively . Pain intensity was measured using both the Oucher and the Children 's Hospital of Eastern Ontario Pain Scale ( CHEOPS ) to allow for comparison between self‐report and behavioral measures of pain intensity . Severity of postoperative bleeding was measured using a 4‐point rating scale . The EXP group had a significant reduction in total fentanyl dose ( mean : 35.9 & mgr;g ) compared to the CTL group ( mean : 48.3 & mgr;g , t = −2.21 , P < 0.03 ) . There was a statistically significant decrease in pre‐fentanyl CHEOPS scores in the Post‐Anesthesia Care Unit ( PACU ) in the ketorolac group ( F ( 2,30 ) = 5.34 , P < 0.01 ) , but not in the saline group ( F ( 2.24 ) = 2.46 , P > 0.05 ) . In the first hour postoperatively , the CHEOPS demonstrated significant decreases in pain intensity scores in response to opioids , in both groups . In the PACU , children were unable to provide a self‐report of pain intensity potentially due to a variety of factors ( e.g. , emergence delirium , agitation , excitement , sedation , and /or pain ) . However , during the remainder of the postoperative stay , the photographic scale of the Oucher was a more valid measure of pain intensity than the CHEOPS . There were no differences between the 2 groups in the severity of postoperative bleeding . Children in the EXP group were discharged significantly earlier ( i.e. , 30 min , t = −2.22 , P < 0.03 ) . Our data demonstrate that i.m . administration of ketorolac , at the end of surgery , significantly reduces opioid requirements and shortens length of stay without any evidence of increased bleeding . In addition , our data suggest that the patient 's altered level of consciousness and attention span may diminish the utility of self‐report measures of  pain intensity  in the immediate postoperative period Purpose To compare the incidence of vomiting following codeine or ketorolac for tonsillectomy in children . Methods We had planned to enrol 240 patients , aged 2–12 yr undergoing elective tonsillectomy into a r and omized , single-blind study in University Children ’s Hospital . The study was terminated , after 64 patients because interim analysis of the data by a blinded non- study scientist concluded that the patients were at undue risk of excessive perioperative bleeding . After induction of anaesthesia by inhalation with N2O/halothane or with propofol 2.5−3.5 mg · kg−1 iv , the children were administered 150 μg · kg−1 ondansetron and 50 μg · kg−1 midazolam . Maintenance of anaesthesia was with N2O and halothane in O2 . Subjects were administered either 1.5 mg · kg−1 codeine i m or 1 mg · kg−1 ketorolac iv before the commencement of surgery . Intraoperative blood loss was measured with a Baxter Medi-Vac ® Universal Critical Measurement Unit . Postoperative management of vomiting and pain was st and ardized . Vomiting was recorded for 24 hr after anaesthesia . Data were compared with ANOVA , Chi-Square analysis and Fisher Exact Test . Results Thirty-five subjects received ketorolac . Demographic data were similar . The incidence of vomiting during the postoperative period was 31 % in the codeine-group and 40 % in the ketorolac-group  . Intraoperative blood losses was 1.3 ± 0.8 ml · kg−1 after codeine and 2.2 ± 1.9 ml · kg−1 after ketorolac ( mean ± SD ) P < 0.05 . Five ketorolac-treated patients had bleeding which led to unscheduled admission to hospital , P < 0.05 , Exact Test . Conclusion Preoperative ketorolac increases perioperative bleeding among children undergoing tonsillectomy without beneficial effects . RésuméObjectifComparer l’incidence des vomissements après l’analgésie au kétorolac et à la codéine chez les amygdalectomisés . MéthodesLes auteurs prévoyaient inclure 240 patients âgés de 2 à 12 ans programmés pour une amygdalectomie réglée dans cette étude aléatoire en simple aveugle . L’étude a été terminée après 64 patients après qu’une analyse intérimaire des données par un scientifique sans implication dans l’étude eût montré que les patients étaient soumis à un risque excessif de saignement postopératoire . Après l’induction de l’anesthésie à l’halothane/N2O et au propofol 2,5 - 3,5 mg · kg−1 iv , les enfants ont reçu 150 μg · kg−1 d’ondensetron et 50 μg · kg−1 de midazolam . L’anesthésie a été entretenue avec du N2O et de l’halothane en O2 . Les sujets ont ensuite reçu soit de la codéine 1,5 mg·kg−1 i m soit du kétorolac 1 mg · kg−1 iv avant la chirurgie . La perte sanguine peropératoire a été déterminée avec une dispositif de mesure Baxter Medi-Vac ® . Le traitement postopératoire des vomissements et de la douleur a été uniforme . Les vomissements ont été enregistrés pendant 24 heures après l’anesthésie . Les données ont été comparées par ANOVA , l’analyse du Chi2 et le test d’exactitude de Fisher . RésultatsTrente-cinq enfants ont reçu du kétorolac .  Les données démographiques étaient identiques . L’incidence des vomissements en postopératoire a été de 31 % dans le groupe codéine et de 40 % dans le groupe kétorolac . Les pertes sanguines peropératoires ont été de 1,3 ± 0,8 ml · kg−1 après la codéine et de 2,2 ± 1,9 ml · kg−1 après le kétorolac ( moyenne ± ET ) , P < 0,05 . Cinq patients traités au kétorolac ont eu des saignements qui ont nécessité une réadmission à l’hôpital , P < 0,05 . Conclusion Le kétorolac administré en préopératoire augmente sans effets bénéfiques les saignements périopératoires chez les enfants amygdalectomisés The efficacy of benzydamine hydrochloride ( Difflam ) spray to relieve pain from postoperative tonsillectomy was assessed , but it was found that it did not relieve the symptoms after operation when compared to matching placebo 127 children scheduled for elective tonsillectomy or adenotonsillectomy were studied . Anaesthesia was induced with propofol and maintained with a volatile agent . At induction the child received either rectal diclofenac 1 mg.kg-1 with or without fentanyl 0.75 microgram.kg-1 i.v . , or intravenous tenoxicam 0.4 mg.kg-1 with or without fentanyl 0.75 microgram.kg-1 i.v . Blood loss was measured peroperatively . Nausea and vomiting scores , sedation scores and pain scores were recorded in the recovery room , at one , two , four and eight h postoperatively and at discharge . There were no significant differences in blood loss between the groups or between nausea and vomiting scores . Pain scores in the tenoxicam without fentanyl group were significantly higher in recovery ( P < 0.05 ) than the diclofenac group without fentanyl and both fentanyl groups . This group required supplemental analgesia earlier although this was not significant . The pain scores in the diclofenac with fentanyl group were significantly lower at one h and four h than the group receiving diclofenac alone ( P = 0.008 and 0.02 respectively ) BACKGROUND We investigated the effect of preincisional rectal diclofenac on pain scores and postoperative morphine requirements of children undergoing tonsillectomy after remifentanil-propofol anaesthesia  in a r and omized clinical trial . METHODS Induction and maintenance of anaesthesia were with remifentanil and propofol .  Forty children were r and omly assigned into two groups before incision . The diclofenac group ( n=20 ) received diclofenac suppositories ( approximately 1 mg x kg(-1 ) ) and the control group ( n=20 ) received no treatment . Following discontinuation of remifentanil , patient-controlled analgesia ( PCA ) with morphine ( a loading dose 50 micro g x kg(-1 ) , a background infusion 4 micro g x kg(-1 ) x h(-1 ) and a dem and dose 20 micro g x kg(-1 ) with 5-min intervals ) was started . We assessed pain score [ verbal analogue scales ( VAS ) , 0 - 10 ] and sedation level at 5-min intervals and recorded the total morphine consumption of the first hour in the PACU . Patients were discharged to the ward with a new PCA morphine programme ( a dem and dose 20 micro g.kg-1 with a lockout time of 30 min , for 4 h ) , and total morphine consumption was recorded . RESULTS The mean VAS score of the diclofenac group was significantly lower than the control group on arrival in the PACU ( 2.85 + /- 0.77 , 7.60 + /- 0.83 , respectively , P < 0.01 ) and it remained significantly lower in the PACU stay of the children . The mean total morphine consumption of the diclofenac group was less than the control group in the PACU ( 130.33 + /- 11.26 and 169.92 + /- 9 
    Output:
    
There is insufficient evidence to exclude an increased risk of bleeding when NSAIDs are used in paediatric tonsillectomy .
They do however confer the benefit of a reduction in vomiting