***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 OBJECTIVE The study was carried out to compare the analgesic effect of diclofenac sodium and indomethacin suppositories for management of right mediolateral episiotomy repair . METHOD A total of 70 patients who gave birth vaginally with right mediolateral episitomy were r and omly assigned to receive 100 mg diclofenac sodium suppositories/day ( G1 , n = 35 ) or 100 mg indomethacin supposotories/day ( G2 , n = 35 ) after episiotomy repair and postpartum for three days . Pain ratings were recorded before , the first hour and 24 hours after medication . The verbal rating scale ( VRS ) and visual analog scale ( VAS ) were used for pain recording . The independent T test , Mann-Whitney U and Wilcoxon rank test were used for statistical analysis and Spearman correlation analysis was used for comparison between VRS and VAS . RESULTS Diclofenac sodium was a more effective analgesic than indomethacin suppositories for right mediolateral episiotomy pain . For G1 the first hour VRS was 2.6 + /- 0.5 points and VAS 4.9 + /- 0.8 points ; for G2 the first hour VRS was 3.4 + /- 0.6 points VAS 6.6 + /- 1.2 points ; this difference was statistically significant ( p < 0.05 , Mann-Whitney U test ) . For G1 at the 24th hour VRS was 1.2 + /- 0.4 points and VAS 2.4 + /- 0.9 points ; for G2 at the 24th hour VRS was 2 + /- 0.7 points and VAS was 3.4 + /- 1.3 points ; the difference was statistically significant ( p < 0.05 , Mann-Whitney U test ) . The first and 24th hour pain scores ( VAS1-VAS24 , VRS1-VRS24 ) were decreased dramatically for both groups ( p < 0.05 , Wilcoxon rank test ) . A positive correlation was obtained between the first and 24th hour VRS and VAS by Spearman correlation analysis ( r(s ) = 0.9 , n = 70 , p = 0.000 ) . CONCLUSION The two analgesics were effective after episiotomy repair , however diclofenac sodium suppositories may be the preferred choice because they were more effective 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 Background : Pain is a worldwide problem that often originates from disease process , and diagnostic and treatment procedures such as surgical operations . Objectives : This trial was performed to compare the effectiveness of two analgesics for the management of  perineal pain caused by episiotomy . Material s and Methods : A total of 170 nulliparous women who gave birth vaginally with episiotomy between March 2009 and November 2010 were r and omly assigned to receive either ibuprofen or celecoxib which were given orally every 6 or 12 hours , respectively . Pain levels were measured before the intervention , and at 1 , 2 , 4 , 8 and 12 hours after providing the first dose on a 10-cm visual analogue scale . Results : The results showed that the two groups had no significant differences regarding demographic characteristics , maternal , neonatal , and post-delivery factors , and mean premedication pain severity . Means of pain severity were different between the two groups as patients in the celecoxib group had lower means than the other group at 1,2,4,8 and 12 hours ( 4.01 ± 1.8 vs. 4.46 ± 1.9 , 3.17 ± 1.9 vs. 3.79 ± 1.7 , 2.89 ± 1.3 vs. 2.96 ± 1.5 , 2.19 ± 1.8 vs. 2.55 ± 1.4 , and 1.98 ± 1.1 vs. 2.45 ± 1.2 , respectively ) after administration of analgesics . Conclusions : Patients who received celecoxib had lower VAS in comparison with others . Although these differences were not significant , as celecoxib has longer half-life , fewer upper GI symptoms , and is better tolerated based on the previous studies , and this study is in favor of using it 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 To determine the efficacy and safety of 2 inexpensive and easily deliverable antiretroviral ( ARV ) regimens for the prevention of mother-to-child transmission ( MTCT ) of human immunodeficiency virus ( HIV ) type 1 during labor and delivery , HIV-infected pregnant women were screened at 11 maternity health institutions in South Africa and were enrolled in an open-label short course ARV regimen of either nevirapine ( Nvp ) or multiple-dose zidovudine and lamivudine ( Zdv/3TC ) . The overall estimated HIV-1 infection rates in 1307 infants by 8 weeks were 12.3 % ( 95 % confidence interval [ CI ] , 9.7 - 15.0 ) for Nvp and 9.3 % ( 95 % CI , 7.0 - 11.6 ) for Zdv/3TC ( P=.11 ) . Excluding infections detected within 72 h ( intrauterine ) , new HIV-1 infections were detected in 5.7 % ( 95 % CI , 3.7 - 7.8 ) and 3.6 % ( 95 % CI , 2 
    Output:
    
Neonatal adverse effects were not assessed in any of the included studies .Comparisons of different NSAIDs and different doses of the same NSAID did not demonstrate any differences in their effectiveness on any of the primary outcome measures ; however , few data were available on some NSAIDs .
In women who are not breastfeeding and who sustained perineal trauma , NSAIDs ( compared to placebo ) provide greater pain relief for acute postpartum perineal pain and fewer women need additional analgesia when treated with a NSAID .