human
***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: & NA ; In the present study , we examined the effects of preoperative electroacupuncture ( EA ) at classical bilateral acupuncture points ( Zusanli , also known as ST‐36 ) on postoperative pain and opioid‐related side effects . One hundred healthy consenting women undergoing lower abdominal surgery were r and omly assigned to four treatment regimens : Group I ( n=25 ) , control ; Group II ( n=25 ) , sham‐EA ( needle insertion without electrical stimulation ) ; Group III ( n=25 ) , low‐EA ( 2 Hz of electrical stimulation ) ; and Group IV ( n=25 ) , high‐EA ( 100 Hz of electrical stimulation ) . EA groups received needle insertion with or without electrical stimulation 20 min prior to anesthesia . All patients received patient‐controlled analgesia ( PCA ) of morphine postoperation . Postoperative pain was evaluated by recording ( 1 ) the time of the first required analgesic , ( 2 ) the number of PCA dem and s , ( 3 ) the total amount of morphine required by PCA , and ( 4 ) patients ' VAS pain score . We found that the time of first analgesic requested was 10 , 18 , 28 , and 28 min in the control , sham‐ , low‐ , and high‐EA groups , respectively . During the first 24 h , the total amount of morphine required was decreased by 21 , 43 and 61 % in the sham‐ , low‐ and high‐EA groups , respectively . The incidence of nausea and dizziness during the first 24 h after surgery was significantly reduced in both the low‐EA and high‐EA groups compared with the control and sham‐EA groups . We also found that sham‐EA exerts a beneficial effect with respect to its pain relieving quality but not the side effect profiles . Our findings demonstrates that preoperative treatment with low‐EA and high‐EA can reduce postoperative analgesic requirements and associated side effects in patients undergoing lower abdominal surgery Abstract Objective : The present study aims to determine the efficiency and reliability of transcutaneous electrical nerve stimulation ( TENS ) in the management of  pain related with uterine contractions after vaginal delivery and the pain related with both abdominal incision uterine contractions after cesarean section . Methods : A hundred healthy women who underwent cesarean section under general anesthesia were r and omly assigned to the placebo group ( Group 1 ) or the TENS group ( Group 2 ) , while 100 women who delivered by vaginal route without episiotomy were r and omized into the placebo group ( Group 3 ) or the TENS group ( Group 4 ) . Results : The patients in Group 2 had statistically lower visual analog scale ( VAS ) and verbal numerical scale ( VNS ) scores than the patients in Group 1 ( p < 0.001 for both ) . The patients in Group 4 had statistically lower VAS and VNS scores than the patients in Group 3 ( p = 0.022 and p = 0.005 , respectively ) . The analgesic requirement at the eighth hour of cesarean section was significantly lower in the patients who were treated with TENS ( p = 0.006 ) . The need for analgesics at the eighth hour of vaginal delivery was statistically similar in the patients who were treated with TENS and the patients who received placebo ( p = 0.830 ) . Conclusion : TENS is an effective , reliable , practical and easily available modality of treatment for postpartum pain Objectives To study the analgesic effect of electroacupuncture ( EA ) as perioperative adjunctive therapy added to a systemic analgesic strategy ( including tramadol and ketamine ) for postoperative pain , opioid-related side effects and patient satisfaction . Methods In a sham-controlled participant- and observer-blinded trial , 75 patients undergoing radical prostatectomy were r and omly assigned to two groups : ( 1 ) EA ( n=37 ; tramadol+ketamine+EA ) and ( 2 ) control ( n=38 ; tramadol+ketamine ) . EA ( 100 Hz frequency ) was applied at LI4 bilaterally during the closure of the abdominal walls and EA ( 4 Hz ) was applied at ST36 and LI4 bilaterally immediately after extubation . The control group had sham acupuncture without penetration or stimulation . The following outcomes were evaluated : postoperative pain using the Numerical Rating Scale ( NRS ) and McGill Scale ( SF_MPQ ) , mechanical pain thresholds using algometer application close to the wound , cortisol measurements , rescue analgesia , Spielberger State Trait Anxiety Inventory ( STAI Y-6 item ) , patient satisfaction and opioid side effects . Results Pain scores on the NRS and SF_MPQ were significantly lower and electronic pressure algometer measurements were significantly higher in the EA group than in the control group ( p<0.001 ) at all assessment s. In the EA group a significant decrease in rescue analgesia was observed at 45 min ( p<0.001 ) and a significant decrease in cortisol levels was also observed ( p<0.05 ) . Patients expressed satisfaction with the analgesia , especially in the EA group ( p<0.01 ) . Significant delays in the start of bowel movements were observed in the control group at 45 min ( p<0.001 ) and 2 h ( p<0.05 ) . Conclusions Adding EA perioperatively should be considered an option as part of a multimodal analgesic strategy This study examined the effects of needle-free electroacupuncture , at ST36 on postoperative pain following hysterectomy . Based on a double-blind , sham and different intervention controlled clinical experimental design , 47 women were r and omly allocated to four different groups . Except for those in the control group ( Group 1 , n = 13 ) , a course of treatment was given of either sham ( Group 2 , n = 12 ) , high-frequency stimulation ( Group 3 , n = 12 ) , or low-frequency stimulation ( Group 4 , n = 10 ) . All groups were assessed during the postoperative period for 24 hours . The Visual Analogue Scale was used to determine the amount of perceived pain felt by each subject . Differences were found between the means postoperatively at three , four , eight , 16 and 24 hours . Post hoc comparison tests indicated that Group 4 was significantly different from Groups 1 , 2 , and 3 at 24 hours . A one-way ANOVA analysis for total patient-controlled analgesia dem and and doses indicated significant differences between the groups F(3 , 42 ) = 3.59 , P < .05 . Post hoc analysis confirmed the differences between Groups 1 ( M = 84.54 ) and 4 ( M = 41.60 ) . Treatment outcomes of this therapy showed a positive effect for the management of postoperative pain The potential benefit of nonpharmacological adjunctive therapy is not well-studied following major abdominal surgery . The aim of the present study was to investigate transcutaneous electrical nerve stimulation ( TENS ) as a complementary nonpharmacological analgesia intervention during weaning from epidural analgesia ( EDA ) after open lower abdominal surgery . Patients were r and omized to TENS and sham TENS during weaning from EDA . The effects on pain at rest , following short walk , and after deep breath were assessed by visual analog scale ( VAS ) grading . Number of patients assessed was lower than calculated because of change in clinical routine . Pain scores overall were low . A trend of lower pain scores was observed in the active TENS group of patients ; a statistical significance between the groups was found for the pain lying prone in bed ( p < .05 ) . This controlled pilot study indicates benefits of TENS use in postoperative pain management during weaning from EDA after open colon surgery . Further studies are warranted in order to verify the potential beneficial effects from TENS during weaning from EDA after open , lower abdominal surgery The present prospect i ve survey was conducted in a 1200-bed hospital to examine postoperative patients ' current pain intensity , most intense pain experienced , satisfaction with postoperative pain management , and differences regarding pain and satisfaction levels .  All adult patients admitted to a hospital in Hong Kong for surgery , except those receiving local anesthesia , were eligible to enter this study . The patient outcome question naire developed by the American Pain Society was used to solicit data about patients ' pain and satisfaction with pain relief . The subjects were 294 postoperative patients . Approximately 85 % complained about varying degrees of pain during the 24 h prior to the assessment of their pain . When interviewed , most patients complained of mild to moderate pain ( median = 2 on a 10-point scale ) , while the median for ' worst pain intensity ' was 5 . Approximately 80 % of the subjects indicated that both the nurses and physicians reminded them to report pain when it occurred . Only 143 ( 48.6 % ) agreed that the nurses and physicians sufficiently emphasized the importance of pain relief . Those who received acute pain services , provided by anesthetists , reported lower levels of current pain intensity . Over 65 % of the subjects were satisfied with all levels of health care providers , regarding their postoperative pain management Minute sphere acupressure has been used for more than 2000 yr and remains popular in Japan . The points most relevant to abdominal surgery are those associated with meridian flows crossing or originating in the abdomen . We tested the hypothesis that minute sphere therapy reduces pain and analgesic requirements after open abdominal surgery . Participating patients were given st and ardized desflurane and fentanyl anesthetic .  On completion of surgery , they were r and omly assigned to untreated control or minute sphere acupressure at the Neiguan , Zusanli , Sanyinjiao , and Gongsun points . Each site was covered with bulky gauze dressings so that patients could not determine their assignments . Postoperative pain was treated with IV morphine via a patient-controlled analgesia pump . Our primary a priori end-points were pain and opioid consumption on the first postoperative morning . Data are reported as median ( 25th percentile , 75th percentile ) . Fifty-three patients ( 30 controls and 23 minute spheres ) completed the study .  Morphine requirements ( 47 mg [ 27 , 58 ] vs 41 mg [ 25 , 69 ] ) and pain scores ( 29.5 mm [ 16 , 59 ] vs 40 mm [ 22 , 58 ] ) were similar in the control and acupressure groups . These data provide an 80 % power for detecting a 50 % difference in morphine consumption at an alpha of 0.05 . Minute sphere treatment at the Neiguan , Zusanli , Sanyinjiao , and Gongsun points thus failed to provide analgesia after abdominal surgery . Minute sphere therapy is a form of acupuncture . We tested whether minute spheres placed on three acupressure points relevant to abdominal surgery reduced pain and morphine requirements after abdominal surgery . Treatment and control patients received a similar covering . Neither pain nor morphine requirements were different between the groups AIM This study investigated the effect of high frequency transcutaneous electric nerve stimulation ( TENS ) as a pain relieving complementary therapy at the transition from epidural ( EDA ) to general analgesia after pancreatic surgery by horizontal , abdominal incision . METHOD Fifty-five consecutive patients undergoing pancreatic resection were enrolled in the study and r and omly assigned to active or sham TENS treatment .  Twenty subjects were included in the analysis . Pain , quality of recovery and additional analgesia consumption were measured during the 24 h of transition from EDA to general analgesia . RESULTS Additional analgesic consumption and pain estimations at 24 h after EDA termination differed between the two groups , but was not statistically significant . CONCLUSION This study did not find support to reject use of high frequency TENS as complement during transition from EDA to general analgesia after major abdominal surgery with horizontal incision Background In a controlled and double-blind study , the authors tested the hypothesis that preoperative insertion of intradermal needles at acupoints 2.5 cm from the spinal vertebrae ( bladder meridian ) provide satisfactory postoperative analgesia . Methods The authors enrolled patients scheduled for elective upper and lower abdominal surgery . Before anesthesia , patients undergoing each type of surgery were r and omly assigned to one of two groups : acupuncture ( n = 50 and n = 39 for upper and lower abdominal surgery , respectively ) or control ( n = 48 and n = 38 for upper and lower abdominal surgery , respectively ) . In the acupuncture group , intradermal needles were inserted to the left and right of bladder meridian 18–24 and 20–26 in upper and lower abdominal surgery before induction of anesthesia , respectively . Postoperative analgesia was maintained with epidural morphine and bolus doses of intravenous morphine .  Consumption of intravenous morphine  was recorded . Incisional pain at rest and during coughing and deep visceral pain were recorded during recovery and for 4 days thereafter on a four-point verbal rating scale . We also evaluated time-dependent changes in plasma concentrations of cortisol and catecholamines . Results Starting from the recovery room , intradermal acupuncture increased the fraction of patients with good pain relief as compared with the control ( P < 0.05 ) . Consumption of supplemental intravenous morphine was reduced 50 % , and the incidence of postoperative nausea was reduced 20–30 % in the acupuncture patients who had undergone either upper or lower abdominal surgery ( P < 0.01 ) . Plasma cortisol and epinephrine concentrations were reduced 30–50 % in the acupuncture group during 
    Output:
    
agent
***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: & NA ; In the present study , we examined the effects of preoperative electroacupuncture ( EA ) at classical bilateral acupuncture points ( Zusanli , also known as ST‐36 ) on postoperative pain and opioid‐related side effects . One hundred healthy consenting women undergoing lower abdominal surgery were r and omly assigned to four treatment regimens : Group I ( n=25 ) , control ; Group II ( n=25 ) , sham‐EA ( needle insertion without electrical stimulation ) ; Group III ( n=25 ) , low‐EA ( 2 Hz of electrical stimulation ) ; and Group IV ( n=25 ) , high‐EA ( 100 Hz of electrical stimulation ) . EA groups received needle insertion with or without electrical stimulation 20 min prior to anesthesia . All patients received patient‐controlled analgesia ( PCA ) of morphine postoperation . Postoperative pain was evaluated by recording ( 1 ) the time of the first required analgesic , ( 2 ) the number of PCA dem and s , ( 3 ) the total amount of morphine required by PCA , and ( 4 ) patients ' VAS pain score . We found that the time of first analgesic requested was 10 , 18 , 28 , and 28 min in the control , sham‐ , low‐ , and high‐EA groups , respectively . During the first 24 h , the total amount of morphine required was decreased by 21 , 43 and 61 % in the sham‐ , low‐ and high‐EA groups , respectively . The incidence of nausea and dizziness during the first 24 h after surgery was significantly reduced in both the low‐EA and high‐EA groups compared with the control and sham‐EA groups . We also found that sham‐EA exerts a beneficial effect with respect to its pain relieving quality but not the side effect profiles . Our findings demonstrates that preoperative treatment with low‐EA and high‐EA can reduce postoperative analgesic requirements and associated side effects in patients undergoing lower abdominal surgery Abstract Objective : The present study aims to determine the efficiency and reliability of transcutaneous electrical nerve stimulation ( TENS ) in the management of  pain related with uterine contractions after vaginal delivery and the pain related with both abdominal incision uterine contractions after cesarean section . Methods : A hundred healthy women who underwent cesarean section under general anesthesia were r and omly assigned to the placebo group ( Group 1 ) or the TENS group ( Group 2 ) , while 100 women who delivered by vaginal route without episiotomy were r and omized into the placebo group ( Group 3 ) or the TENS group ( Group 4 ) . Results : The patients in Group 2 had statistically lower visual analog scale ( VAS ) and verbal numerical scale ( VNS ) scores than the patients in Group 1 ( p < 0.001 for both ) . The patients in Group 4 had statistically lower VAS and VNS scores than the patients in Group 3 ( p = 0.022 and p = 0.005 , respectively ) . The analgesic requirement at the eighth hour of cesarean section was significantly lower in the patients who were treated with TENS ( p = 0.006 ) . The need for analgesics at the eighth hour of vaginal delivery was statistically similar in the patients who were treated with TENS and the patients who received placebo ( p = 0.830 ) . Conclusion : TENS is an effective , reliable , practical and easily available modality of treatment for postpartum pain Objectives To study the analgesic effect of electroacupuncture ( EA ) as perioperative adjunctive therapy added to a systemic analgesic strategy ( including tramadol and ketamine ) for postoperative pain , opioid-related side effects and patient satisfaction . Methods In a sham-controlled participant- and observer-blinded trial , 75 patients undergoing radical prostatectomy were r and omly assigned to two groups : ( 1 ) EA ( n=37 ; tramadol+ketamine+EA ) and ( 2 ) control ( n=38 ; tramadol+ketamine ) . EA ( 100 Hz frequency ) was applied at LI4 bilaterally during the closure of the abdominal walls and EA ( 4 Hz ) was applied at ST36 and LI4 bilaterally immediately after extubation . The control group had sham acupuncture without penetration or stimulation . The following outcomes were evaluated : postoperative pain using the Numerical Rating Scale ( NRS ) and McGill Scale ( SF_MPQ ) , mechanical pain thresholds using algometer application close to the wound , cortisol measurements , rescue analgesia , Spielberger State Trait Anxiety Inventory ( STAI Y-6 item ) , patient satisfaction and opioid side effects . Results Pain scores on the NRS and SF_MPQ were significantly lower and electronic pressure algometer measurements were significantly higher in the EA group than in the control group ( p<0.001 ) at all assessment s. In the EA group a significant decrease in rescue analgesia was observed at 45 min ( p<0.001 ) and a significant decrease in cortisol levels was also observed ( p<0.05 ) . Patients expressed satisfaction with the analgesia , especially in the EA group ( p<0.01 ) . Significant delays in the start of bowel movements were observed in the control group at 45 min ( p<0.001 ) and 2 h ( p<0.05 ) . Conclusions Adding EA perioperatively should be considered an option as part of a multimodal analgesic strategy This study examined the effects of needle-free electroacupuncture , at ST36 on postoperative pain following hysterectomy . Based on a double-blind , sham and different intervention controlled clinical experimental design , 47 women were r and omly allocated to four different groups . Except for those in the control group ( Group 1 , n = 13 ) , a course of treatment was given of either sham ( Group 2 , n = 12 ) , high-frequency stimulation ( Group 3 , n = 12 ) , or low-frequency stimulation ( Group 4 , n = 10 ) . All groups were assessed during the postoperative period for 24 hours . The Visual Analogue Scale was used to determine the amount of perceived pain felt by each subject . Differences were found between the means postoperatively at three , four , eight , 16 and 24 hours . Post hoc comparison tests indicated that Group 4 was significantly different from Groups 1 , 2 , and 3 at 24 hours . A one-way ANOVA analysis for total patient-controlled analgesia dem and and doses indicated significant differences between the groups F(3 , 42 ) = 3.59 , P < .05 . Post hoc analysis confirmed the differences between Groups 1 ( M = 84.54 ) and 4 ( M = 41.60 ) . Treatment outcomes of this therapy showed a positive effect for the management of postoperative pain The potential benefit of nonpharmacological adjunctive therapy is not well-studied following major abdominal surgery . The aim of the present study was to investigate transcutaneous electrical nerve stimulation ( TENS ) as a complementary nonpharmacological analgesia intervention during weaning from epidural analgesia ( EDA ) after open lower abdominal surgery . Patients were r and omized to TENS and sham TENS during weaning from EDA . The effects on pain at rest , following short walk , and after deep breath were assessed by visual analog scale ( VAS ) grading . Number of patients assessed was lower than calculated because of change in clinical routine . Pain scores overall were low . A trend of lower pain scores was observed in the active TENS group of patients ; a statistical significance between the groups was found for the pain lying prone in bed ( p < .05 ) . This controlled pilot study indicates benefits of TENS use in postoperative pain management during weaning from EDA after open colon surgery . Further studies are warranted in order to verify the potential beneficial effects from TENS during weaning from EDA after open , lower abdominal surgery The present prospect i ve survey was conducted in a 1200-bed hospital to examine postoperative patients ' current pain intensity , most intense pain experienced , satisfaction with postoperative pain management , and differences regarding pain and satisfaction levels .  All adult patients admitted to a hospital in Hong Kong for surgery , except those receiving local anesthesia , were eligible to enter this study . The patient outcome question naire developed by the American Pain Society was used to solicit data about patients ' pain and satisfaction with pain relief . The subjects were 294 postoperative patients . Approximately 85 % complained about varying degrees of pain during the 24 h prior to the assessment of their pain . When interviewed , most patients complained of mild to moderate pain ( median = 2 on a 10-point scale ) , while the median for ' worst pain intensity ' was 5 . Approximately 80 % of the subjects indicated that both the nurses and physicians reminded them to report pain when it occurred . Only 143 ( 48.6 % ) agreed that the nurses and physicians sufficiently emphasized the importance of pain relief . Those who received acute pain services , provided by anesthetists , reported lower levels of current pain intensity . Over 65 % of the subjects were satisfied with all levels of health care providers , regarding their postoperative pain management Minute sphere acupressure has been used for more than 2000 yr and remains popular in Japan . The points most relevant to abdominal surgery are those associated with meridian flows crossing or originating in the abdomen . We tested the hypothesis that minute sphere therapy reduces pain and analgesic requirements after open abdominal surgery . Participating patients were given st and ardized desflurane and fentanyl anesthetic .  On completion of surgery , they were r and omly assigned to untreated control or minute sphere acupressure at the Neiguan , Zusanli , Sanyinjiao , and Gongsun points . Each site was covered with bulky gauze dressings so that patients could not determine their assignments . Postoperative pain was treated with IV morphine via a patient-controlled analgesia pump . Our primary a priori end-points were pain and opioid consumption on the first postoperative morning . Data are reported as median ( 25th percentile , 75th percentile ) . Fifty-three patients ( 30 controls and 23 minute spheres ) completed the study .  Morphine requirements ( 47 mg [ 27 , 58 ] vs 41 mg [ 25 , 69 ] ) and pain scores ( 29.5 mm [ 16 , 59 ] vs 40 mm [ 22 , 58 ] ) were similar in the control and acupressure groups . These data provide an 80 % power for detecting a 50 % difference in morphine consumption at an alpha of 0.05 . Minute sphere treatment at the Neiguan , Zusanli , Sanyinjiao , and Gongsun points thus failed to provide analgesia after abdominal surgery . Minute sphere therapy is a form of acupuncture . We tested whether minute spheres placed on three acupressure points relevant to abdominal surgery reduced pain and morphine requirements after abdominal surgery . Treatment and control patients received a similar covering . Neither pain nor morphine requirements were different between the groups AIM This study investigated the effect of high frequency transcutaneous electric nerve stimulation ( TENS ) as a pain relieving complementary therapy at the transition from epidural ( EDA ) to general analgesia after pancreatic surgery by horizontal , abdominal incision . METHOD Fifty-five consecutive patients undergoing pancreatic resection were enrolled in the study and r and omly assigned to active or sham TENS treatment .  Twenty subjects were included in the analysis . Pain , quality of recovery and additional analgesia consumption were measured during the 24 h of transition from EDA to general analgesia . RESULTS Additional analgesic consumption and pain estimations at 24 h after EDA termination differed between the two groups , but was not statistically significant . CONCLUSION This study did not find support to reject use of high frequency TENS as complement during transition from EDA to general analgesia after major abdominal surgery with horizontal incision Background In a controlled and double-blind study , the authors tested the hypothesis that preoperative insertion of intradermal needles at acupoints 2.5 cm from the spinal vertebrae ( bladder meridian ) provide satisfactory postoperative analgesia . Methods The authors enrolled patients scheduled for elective upper and lower abdominal surgery . Before anesthesia , patients undergoing each type of surgery were r and omly assigned to one of two groups : acupuncture ( n = 50 and n = 39 for upper and lower abdominal surgery , respectively ) or control ( n = 48 and n = 38 for upper and lower abdominal surgery , respectively ) . In the acupuncture group , intradermal needles were inserted to the left and right of bladder meridian 18–24 and 20–26 in upper and lower abdominal surgery before induction of anesthesia , respectively . Postoperative analgesia was maintained with epidural morphine and bolus doses of intravenous morphine .  Consumption of intravenous morphine  was recorded . Incisional pain at rest and during coughing and deep visceral pain were recorded during recovery and for 4 days thereafter on a four-point verbal rating scale . We also evaluated time-dependent changes in plasma concentrations of cortisol and catecholamines . Results Starting from the recovery room , intradermal acupuncture increased the fraction of patients with good pain relief as compared with the control ( P < 0.05 ) . Consumption of supplemental intravenous morphine was reduced 50 % , and the incidence of postoperative nausea was reduced 20–30 % in the acupuncture patients who had undergone either upper or lower abdominal surgery ( P < 0.01 ) . Plasma cortisol and epinephrine concentrations were reduced 30–50 % in the acupuncture group during 
    Output:
    