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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

Smart Technology Improves Patient-Controlled Analgesia: A Preliminary Report

Heiko Rudolph, BA, B Eng (Hon), PhD^*, John F. Cade, MD, PhD, FRACP, FANZCA, FCCP, Peter T. Morley, MB, FRACP, FANZCA, John S. Packer, ME, FIEAust^*, and Brian Lee, Dip Anaes Sci, Cert Elec

*Department of Electrical and Electronic Engineering, The University of Melbourne; and Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia

Address correspondence and reprint requests to Prof. John F. Cade, Intensive Care Unit, Royal Melbourne Hospital, Victoria 3050, Australia.

A new adaptive system has been designed to improve patient-controlled analgesia through the use of a variable bolus dose and a variable background infusion of analgesic. A novel hand set allows patients to rate their own pain on a linear scale of 1 to 10. Data derived from the hand set signals are used by an expert algorithm to repeatedly adapt the drug dosage of the bolus and of the background infusion according to both current pain intensity and the patient’s response to previous dosage. To test the system, we performed a small pilot clinical study, using a randomized, double-blinded, cross-over design. The new system was alternated with a conventional system every 12 h. Use of the new system was associated with significantly lower pain scores and fewer bolus requests but more analgesic administration, though without increased adverse effects. It was very well accepted by both patients and clinical staff.

Implications: Pain relief after surgery is often best provided by patient-controlled analgesia, which uses an IV infusion pump and a patient-activated switch. We have developed a new computer-controlled or "smart" patient-controlled analgesia that rapidly learns a patient’s individual needs and provides continuously tailored pain relief.

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