Pain model and fuzzy logic patient-controlled analgesia in shock-wave lithotripsy

Pain control in conscious patients was investigated using a push-button, demand-driven supply of drugs. A fuzzy logic patient-controlled analgesia (PCA) algorithm was compared with a conventional algorithm, for alfentanil administration in extracorporeal shock-wave lithotripsy. The conventional PCA algorithm used an initial dose of 0.25 mg, a fixed infusion rate of 60 mg h−1 and a fixed bolus size of 0.2 mg with a 1 min lockout. The fuzzy logic PCA algorithm used an initial dose of 0.25 mg, a changeable infusion rate and a bolus size of 0.1 or 0.05 mg. The infusion rate was adjusted according to a look-up table that accepted the button-pressing history over the last three lockout intervals. The look-up table was designed using fuzzy logic. The bolus size was adjusted according to the button-pressing history over the past two lockout intervals. Twelve patients were treated using conventional PCA, and thirteen were treated with PCA + fuzzy logic control (FLC). PCA+FLC patients consumed 45% less drug. Also, PCA-FLC patients had a mean delivery/demand ratio of 82%, compared with 60% in conventional PCA. When the pain intensity scale was analysed, PCA+FLC patients had acceptable pain intensity at 62%, compared with 44% in conventional PCA.

[1]  J A Spain,et al.  Computer‐assisted Continuous Infusions of Fentanyl during Cardiac Anesthesia: Comparison with a Manual Method , 1985, Anesthesiology.

[2]  M. Braae,et al.  FUZZY RELATIONS IN A CONTROL SETTING , 1978 .

[3]  D B Raemer,et al.  The prospective use of population pharmacokinetics in a computer-driven infusion system for alfentanil. , 1990, Anesthesiology.

[4]  D R Stanski,et al.  Decreased fentanyl and alfentanil dose requirements with age. A simultaneous pharmacokinetic and pharmacodynamic evaluation. , 1987, The Journal of pharmacology and experimental therapeutics.

[5]  L B Sheiner,et al.  Simultaneous modeling of pharmacokinetics and pharmacodynamics: application to d-tubocurarine. , 1980, Clinical pharmacology and therapeutics.

[6]  D R Stanski,et al.  Population pharmacokinetics of alfentanil: the average dose-plasma concentration relationship and interindividual variability in patients. , 1987, Anesthesiology.

[7]  H Ying,et al.  Expert-system-based fuzzy control of arterial pressure by drug infusion. , 1988, Medical progress through technology.

[8]  G N Kenny,et al.  Patient-maintained analgesia with target-controlled alfentanil infusion after cardiac surgery: a comparison with morphine PCA. , 1998, British journal of anaesthesia.

[9]  J. Heykants,et al.  Pharmacokinetics of Alfentanil in Man , 1982, Anesthesia and analgesia.

[10]  D. Linkens,et al.  Performance assessment of a fuzzy controller for atracurium-induced neuromuscular block. , 1996, British journal of anaesthesia.

[11]  Derek A. Linkens,et al.  Fuzzy Logic Knowledge-Based Control for Muscle Relaxant Anaesthesia , 1988 .

[12]  Jiann-Shing Shieh,et al.  Modelling of bispectral index using artificial neural networks during inhalational anaesthesia , 2000 .

[13]  I. Kouatli,et al.  An improved design procedure for fuzzy control systems , 1991 .

[14]  B. Kavanagh,et al.  Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. , 1996, The Clinical journal of pain.

[15]  C. Hug,et al.  Variable Rate Infusion of Alfentanil as a Supplement to Nitrous Oxide Anesthesia for General Surgery , 1983, Anesthesia and analgesia.

[16]  E. Marcantonio,et al.  The Impact of Postoperative Pain on the Development of Postoperative Delirium , 1998, Anesthesia and analgesia.

[17]  A Carollo,et al.  A rule-based postoperative pain controller: simulation results. , 1993, International journal of bio-medical computing.

[18]  L E Mather,et al.  Variables of patient‐controlled analgesia 2. concurrent infusion , 1989, Anaesthesia.

[19]  J. Dombi.  Membership function as an evaluation , 1990 .

[20]  Maysam F. Abbod,et al.  A survey of fuzzy logic monitoring and control utilisation in medicine , 2001, Artif. Intell. Medicine.

[21]  A. Woodhouse,et al.  The influence of age upon opioid analgesic use in the patient‐controlled analgesia (PCA) environment , 1997, Anaesthesia.

[22]  D. A. Linkens,et al.  Self-learning fuzzy control of atracurium-induced neuromuscular block during surgery , 1997, Medical and Biological Engineering and Computing.

[23]  D. Ward,et al.  The hybrid model: a new pharmacokinetic model for computer-controlled infusion pumps , 1994, IEEE Transactions on Biomedical Engineering.

[24]  K. Peter,et al.  Pain control during extracorporeal shock wave lithotripsy of gallstones by titrated alfentanil infusion. , 1989, Anesthesiology.

[25]  P. Herbison,et al.  Comparison of Two Methods of Intravenous Administration of Morphine for Postoperative Pain Relief , 1990, Anaesthesia and intensive care.

[26]  G. Schelling,et al.  Patient controlled analgesia for shock wave lithotripsy: the effect of self-administered alfentanil on pain intensity and drug requirement. , 1996, The Journal of urology.

[27]  R. Clayman,et al.  Effect of topical eutectic mixture of local anesthetics on pain response and analgesic requirement during lithotripsy procedures , 1994 .

[28]  M. F. Abbod,et al.  Self-organising fuzzy logic control and the selection of its scaling factors , 1992 .

[29]  D. Linkens,et al.  Self-learning fuzzy logic control of neuromuscular block. , 1997, British journal of anaesthesia.

[30]  Y.F. Li,et al.  Development of fuzzy algorithms for servo systems , 1989, IEEE Control Systems Magazine.

[31]  James C. Scott,et al.  Testing computer-controlled infusion pumps by simulation. , 1988, Anesthesiology.

[32]  Harry Owen,et al.  A Comparison of Variable-Dose Patient-Controlled Analgesia with Fixed-Dose Patient-Controlled Analgesia , 1996, Anesthesia and analgesia.

[33]  Shigeo Abe,et al.  Neural Networks and Fuzzy Systems , 1996, Springer US.

[34]  D A Linkens,et al.  Development of a portable closed-loop atracurium infusion system: systems methodology and safety issues , 1996, International journal of clinical monitoring and computing.

[35]  G. Schelling,et al.  PATIENT CONTROLLED ANALGESIA FOR SHOCK WAVE LITHOTRIPSY , 1989 .

[36]  Harry Owen,et al.  Variable‐dose patient‐controlled analgesia , 1995, Anaesthesia.

[37]  Lewis B. Sheiner,et al.  Simultaneous modeling of pharmacokinetics and pharmacodynamics: Application to d‐tubocurarine , 1979 .

[38]  R. Clayman,et al.  Effect of topical eutectic mixture of local anesthetics on pain response and analgesic requirement during lithotripsy procedures. , 1994, Anesthesia and analgesia.

[39]  Derek A. Linkens,et al.  Hierarchical rule-based and self-organizing fuzzy logic control for depth of anaesthesia , 1999, IEEE Trans. Syst. Man Cybern. Part C.

[40]  J. Dembo.  Comparison of alfentanil and ketamine infusions in combination with midazolam for outpatient lithotripsy , 1992 .