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 Postoperative pain can have a significant effect on patient recovery . An underst and ing of patient attitudes and concerns about postoperative pain is important for identifying ways health care professionals can improve postoperative care . To assess patients ’ postoperative pain experience and the status of acute pain management , we conducted a national study by using telephone question naires . A r and om sample of 250 adults who had undergone surgical procedures recently in the United States was obtained from National Family Opinion . Patients were asked about the  severity of postsurgical pain , treatment , satisfaction with pain medication , patient education , and perceptions about postoperative pain and pain medications .  Approximately 80 % of patients experienced acute pain after surgery . Of these patients , 86 % had moderate , severe , or extreme pain , with more patients experiencing pain after discharge than before discharge . Experiencing postoperative pain was the most common concern ( 59 % ) of patients . Almost 25 % of patients who received pain medications experienced adverse effects ; however , almost 90 % of them were satisfied with their pain medications . Approximately two thirds of patients reported that a health care professional talked with them about their pain . Despite an increased focus on pain management programs and the development of new st and ards for pain management , many patients continue to experience intense pain after surgery . Additional efforts are required to improve patients ’ postoperative pain experience 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 recovery and on the first postoperative day ( P < 0.01 ) . Conclusion Preoperative insertion of intradermal needles reduces postoperative pain , the analgesic requirement , and opioid-related side effects after both upper and lower abdominal surgery . Acupuncture analgesia also reduces the activation of the sympathoadrenal system that normally accompanies surgery One of the challenges of acupuncture research is design ing appropriate control groups . To address this problem , after surgical third molar extraction s 19 patients were r and omly assigned to an acupuncture group ( n = 11 ) or a placebo acupuncture group ( n = 8) . The length of time for reaching moderate pain and pain intensity after oral surgery were recorded by st and ard patient self-report . The results indicated that subjects treated with acupuncture reported longer pain-free duration times ( mean , 181 versus 71 minutes ; p < or = 0.046 ) and experienced less pain intensity than those who received placebo acupuncture . This study provides a model for an acupuncture control that could examine the placebo effect in clinical acupuncture research Acupuncture has been shown to be effective in experimental and clinical acute pain setting s. This study aims to evaluate the effect of preoperative electroacupuncture ( EA ) on intraoperative and postoperative analgesic ( alfentanil and morphine ) requirement in patients scheduled for gynaecologic lower abdominal surgery . Ninety patients were r and omly assigned to one of three groups : Group I ( control group ) –received placebo EA for 45 minutes before induction of general anaesthesia ( GA ) ; Group II –preoperative EA instituted 45 minutes before induction of GA ; Group III – 45 minutes of postoperative EA . The Bispectral Index monitor was used intraoperatively to monitor the hypnotic effect of anaesthetic drugs , and alfentanil was titrated to maintain the blood pressure and pulse rate within ±15 % of basal values . Postoperative pain was managed by intravenous morphine via a patient-controlled analgesia ( PCA ) device . Patients in Group II ( 0.44 ± 0.15μg/kg/min ) received less alfentanil than those in Group III ( 0.58 ± 0.22μg/kg/min ) ( p=0.024 ) , but not significantly less than those in Group I ( 0.51 ± 0.21μg/kg/min ) ( p=0.472 ) . Postoperative morphine consumption was numerically lower in Group II compared with the other groups ; however , the difference was statistically significant only during the period of 6–12 hours between Group II [ 0.03 ( 0.05 ) mg/kg ] and Group I [ 0.10 ( 0.11 ) mg/kg ] ( p=0.015 ) , and Group II and Group III [ 0.08 ( 0.10 ) mg/kg ] ( p=0.010 ) . The 24-hour cumulative morphine consumption for Group II ( 0.52 ± 0.19mg/kg ) was less than that for either Group I ( 0.68 ± 0.38mg/kg ) or Group III ( 0.58 ± 0.27mg/kg ) , but the difference did not reach significance . In conclusion , preoperative EA leads to a reduced intraoperative alfentanil consumption , though this effect may not be specific , and has a morphine sparing effect during the early postoperative period Background : Auricular acupuncture is a promising method for postoperative pain relief . However , there is no evidence for its use after ambulatory surgery . Our aim was to test whether auricular acupuncture is better than invasive needle control for complementary analgesia after ambulatory knee surgery . Methods : One hundred and twenty patients undergoing ambulatory arthroscopic knee surgery under st and ardized general anesthesia were r and omly assigned to receive auricular acupuncture or a control procedure . Fixed indwelling acupuncture needles were inserted before surgery and retained in situ until the following morning . Postoperative rescue analgesia was directed to achieve pain intensity less than 40 mm on a 100-mm visual analogue scale . The primary outcome measure was the postoperative requirement for ibuprofen between surgery and examination the following morning . Results : Intention-to-treat analysis showed that patients from the control group ( n = 59 ) required more ibuprofen than patients from the auricular acupuncture group ( n = 61 ) : median ( interquartile range ) 600 ( 200–800 ) v. 200 ( 0–600 ) mg ( p = 0.012 ) . Pain intensity on a visual analogue scale was similar in both groups at all time points registered . The majority of patients in both groups believed that they had received true acupuncture and wanted to repeat it in future . Interpretation : Auricular acupuncture reduced the requirement for ibuprofen after ambulatory knee surgery relative to an invasive needle control procedure Management of acute and chronic low back and leg pain often includes the use of acupuncture . The effectiveness of this form of therapy is dependent upon compliance , which in turn is dependent on availability , response , treatment of proper acupoints , and the placebo effect . We hypothesized that classical acupuncture would be more effective than placebo acupuncture .  One hundred and thirty-two patients with acute and chronic low back and leg pain were examined before and after surgery for lumbar disc protrusion . Diagnosis was based on CT and MRT findings . Patients received acupuncture drug-free throughout the study period . The visual analogue scale was used to assess pain intensity before and after ( i.e. 30 min . 60 min . 2 h and 6 h ) acupuncture . Classical acupuncture result ed in a significant reduction in pain that become increasingly stronger during the 6h study period . Placebo acupuncture lead to same early pain relief that did not reach statistic significant and then declined thereafter Transcutaneous electrical nerve stimulation ( TENS ) has been used as a complementary ( supplemental ) therapy to opioid analgesics for pain relief after surgery . Simultaneous stimulation at a classical Chinese acupoint site and periincisional dermatomes significantly decreases the postoperative analgesic requirement . This sham-controlled study was design ed to assess the relative effectiveness of acupoint versus nonacupoint stimulation on the postoperative hydromorphone ( HM ) requirement , the incidence of opioid-related side effects , and the overall recovery profile . One hundred women undergoing total abdominal hysterectomy or myomectomy procedures with a st and ardized general anesthesia were r and omly assigned to one of four postoperative analgesic treatment regimens ( n = 25 each ) : Group I = sham-TENS ( no electrical current ) at the Zusanli ( ST36 ) acupoints , Group II = nonacupoint-TENS at the shoulders , Group III = dermatomal-TENS at the level of the surgical incision , and Group IV = acupoint-TENS at the Zusanli acupoints . The frequency of TENS was set in the st and ard dense- and -disperse mode of 2/100 Hz . The intensity of stimulation was set at 0 mA for patients in Group I and at 9 - 12 mA for patients in Groups II , III , and IV . A patient-controlled analgesia ( PCA ) device programmed to deliver bolus doses of HM 0.2 - 0.4 mg IV on dem and with a minimal lockout interval of 10 min was used to quantify the postoperative opioid analgesic requirement . St and ard 100-mm visual analog scales were used to assess pain , as well as sedation , fatigue , and nausea , at specific intervals after surgery . The numbers of PCA dem and s and delivered bolus doses , requirements for supplemental medication , and any opioid-related side effects were recorded . In the first 24 h postoperatively , the opioid requirements in Groups III and IV were decreased by 37 % and 39 % , respectively , compared with the control ( sham ) group and 35 % and 38 % , respectively , compared with Group II . The duration of PCA usage and the incidences of nausea and dizziness were also significantly decreased in Groups III and IV compared with Groups I and II . We conclude that periincisional dermatomal and Zusanli acupoint stimulation were equally effective in decreasing the postoperative opioid analgesic requirement and in reducing opioid-related side effects . Both of these positions were more effective than the nonacupoint ( shoulder ) location . Implication s : The location of the stimulating electrodes seems to be an important determin 
    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 Postoperative pain can have a significant effect on patient recovery . An underst and ing of patient attitudes and concerns about postoperative pain is important for identifying ways health care professionals can improve postoperative care . To assess patients ’ postoperative pain experience and the status of acute pain management , we conducted a national study by using telephone question naires . A r and om sample of 250 adults who had undergone surgical procedures recently in the United States was obtained from National Family Opinion . Patients were asked about the  severity of postsurgical pain , treatment , satisfaction with pain medication , patient education , and perceptions about postoperative pain and pain medications .  Approximately 80 % of patients experienced acute pain after surgery . Of these patients , 86 % had moderate , severe , or extreme pain , with more patients experiencing pain after discharge than before discharge . Experiencing postoperative pain was the most common concern ( 59 % ) of patients . Almost 25 % of patients who received pain medications experienced adverse effects ; however , almost 90 % of them were satisfied with their pain medications . Approximately two thirds of patients reported that a health care professional talked with them about their pain . Despite an increased focus on pain management programs and the development of new st and ards for pain management , many patients continue to experience intense pain after surgery . Additional efforts are required to improve patients ’ postoperative pain experience 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 recovery and on the first postoperative day ( P < 0.01 ) . Conclusion Preoperative insertion of intradermal needles reduces postoperative pain , the analgesic requirement , and opioid-related side effects after both upper and lower abdominal surgery . Acupuncture analgesia also reduces the activation of the sympathoadrenal system that normally accompanies surgery One of the challenges of acupuncture research is design ing appropriate control groups . To address this problem , after surgical third molar extraction s 19 patients were r and omly assigned to an acupuncture group ( n = 11 ) or a placebo acupuncture group ( n = 8) . The length of time for reaching moderate pain and pain intensity after oral surgery were recorded by st and ard patient self-report . The results indicated that subjects treated with acupuncture reported longer pain-free duration times ( mean , 181 versus 71 minutes ; p < or = 0.046 ) and experienced less pain intensity than those who received placebo acupuncture . This study provides a model for an acupuncture control that could examine the placebo effect in clinical acupuncture research Acupuncture has been shown to be effective in experimental and clinical acute pain setting s. This study aims to evaluate the effect of preoperative electroacupuncture ( EA ) on intraoperative and postoperative analgesic ( alfentanil and morphine ) requirement in patients scheduled for gynaecologic lower abdominal surgery . Ninety patients were r and omly assigned to one of three groups : Group I ( control group ) –received placebo EA for 45 minutes before induction of general anaesthesia ( GA ) ; Group II –preoperative EA instituted 45 minutes before induction of GA ; Group III – 45 minutes of postoperative EA . The Bispectral Index monitor was used intraoperatively to monitor the hypnotic effect of anaesthetic drugs , and alfentanil was titrated to maintain the blood pressure and pulse rate within ±15 % of basal values . Postoperative pain was managed by intravenous morphine via a patient-controlled analgesia ( PCA ) device . Patients in Group II ( 0.44 ± 0.15μg/kg/min ) received less alfentanil than those in Group III ( 0.58 ± 0.22μg/kg/min ) ( p=0.024 ) , but not significantly less than those in Group I ( 0.51 ± 0.21μg/kg/min ) ( p=0.472 ) . Postoperative morphine consumption was numerically lower in Group II compared with the other groups ; however , the difference was statistically significant only during the period of 6–12 hours between Group II [ 0.03 ( 0.05 ) mg/kg ] and Group I [ 0.10 ( 0.11 ) mg/kg ] ( p=0.015 ) , and Group II and Group III [ 0.08 ( 0.10 ) mg/kg ] ( p=0.010 ) . The 24-hour cumulative morphine consumption for Group II ( 0.52 ± 0.19mg/kg ) was less than that for either Group I ( 0.68 ± 0.38mg/kg ) or Group III ( 0.58 ± 0.27mg/kg ) , but the difference did not reach significance . In conclusion , preoperative EA leads to a reduced intraoperative alfentanil consumption , though this effect may not be specific , and has a morphine sparing effect during the early postoperative period Background : Auricular acupuncture is a promising method for postoperative pain relief . However , there is no evidence for its use after ambulatory surgery . Our aim was to test whether auricular acupuncture is better than invasive needle control for complementary analgesia after ambulatory knee surgery . Methods : One hundred and twenty patients undergoing ambulatory arthroscopic knee surgery under st and ardized general anesthesia were r and omly assigned to receive auricular acupuncture or a control procedure . Fixed indwelling acupuncture needles were inserted before surgery and retained in situ until the following morning . Postoperative rescue analgesia was directed to achieve pain intensity less than 40 mm on a 100-mm visual analogue scale . The primary outcome measure was the postoperative requirement for ibuprofen between surgery and examination the following morning . Results : Intention-to-treat analysis showed that patients from the control group ( n = 59 ) required more ibuprofen than patients from the auricular acupuncture group ( n = 61 ) : median ( interquartile range ) 600 ( 200–800 ) v. 200 ( 0–600 ) mg ( p = 0.012 ) . Pain intensity on a visual analogue scale was similar in both groups at all time points registered . The majority of patients in both groups believed that they had received true acupuncture and wanted to repeat it in future . Interpretation : Auricular acupuncture reduced the requirement for ibuprofen after ambulatory knee surgery relative to an invasive needle control procedure Management of acute and chronic low back and leg pain often includes the use of acupuncture . The effectiveness of this form of therapy is dependent upon compliance , which in turn is dependent on availability , response , treatment of proper acupoints , and the placebo effect . We hypothesized that classical acupuncture would be more effective than placebo acupuncture .  One hundred and thirty-two patients with acute and chronic low back and leg pain were examined before and after surgery for lumbar disc protrusion . Diagnosis was based on CT and MRT findings . Patients received acupuncture drug-free throughout the study period . The visual analogue scale was used to assess pain intensity before and after ( i.e. 30 min . 60 min . 2 h and 6 h ) acupuncture . Classical acupuncture result ed in a significant reduction in pain that become increasingly stronger during the 6h study period . Placebo acupuncture lead to same early pain relief that did not reach statistic significant and then declined thereafter Transcutaneous electrical nerve stimulation ( TENS ) has been used as a complementary ( supplemental ) therapy to opioid analgesics for pain relief after surgery . Simultaneous stimulation at a classical Chinese acupoint site and periincisional dermatomes significantly decreases the postoperative analgesic requirement . This sham-controlled study was design ed to assess the relative effectiveness of acupoint versus nonacupoint stimulation on the postoperative hydromorphone ( HM ) requirement , the incidence of opioid-related side effects , and the overall recovery profile . One hundred women undergoing total abdominal hysterectomy or myomectomy procedures with a st and ardized general anesthesia were r and omly assigned to one of four postoperative analgesic treatment regimens ( n = 25 each ) : Group I = sham-TENS ( no electrical current ) at the Zusanli ( ST36 ) acupoints , Group II = nonacupoint-TENS at the shoulders , Group III = dermatomal-TENS at the level of the surgical incision , and Group IV = acupoint-TENS at the Zusanli acupoints . The frequency of TENS was set in the st and ard dense- and -disperse mode of 2/100 Hz . The intensity of stimulation was set at 0 mA for patients in Group I and at 9 - 12 mA for patients in Groups II , III , and IV . A patient-controlled analgesia ( PCA ) device programmed to deliver bolus doses of HM 0.2 - 0.4 mg IV on dem and with a minimal lockout interval of 10 min was used to quantify the postoperative opioid analgesic requirement . St and ard 100-mm visual analog scales were used to assess pain , as well as sedation , fatigue , and nausea , at specific intervals after surgery . The numbers of PCA dem and s and delivered bolus doses , requirements for supplemental medication , and any opioid-related side effects were recorded . In the first 24 h postoperatively , the opioid requirements in Groups III and IV were decreased by 37 % and 39 % , respectively , compared with the control ( sham ) group and 35 % and 38 % , respectively , compared with Group II . The duration of PCA usage and the incidences of nausea and dizziness were also significantly decreased in Groups III and IV compared with Groups I and II . We conclude that periincisional dermatomal and Zusanli acupoint stimulation were equally effective in decreasing the postoperative opioid analgesic requirement and in reducing opioid-related side effects . Both of these positions were more effective than the nonacupoint ( shoulder ) location . Implication s : The location of the stimulating electrodes seems to be an important determin 
    Output:
    