Smart technology improves patient-controlled analgesia: A preliminary report

A new adaptive system has been designed to improve patient-controlled analg esia through the use of a variable bolus dose and a variable background inf usion 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 u sed by an expert algorithm to repeatedly adapt the drug dosage of the bolus and of the background infusion according to both current pain intensity an d the patient's response to previous dosage. To test the system, we perform ed 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 s cores and fewer bolus requests but more analgesic administration, though wi thout 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 an d a patient-activated switch. We have developed a new computer-controlled o r "smart" patient-controlled analgesia that rapidly learns a patient's indi vidual needs and provides continuously tailored pain relief.