Nociception Monitoring – The Path to Personalized Analgesia

Nociception Monitoring – The Path to Personalized Analgesia

This article is supported by our partner, Medasense Biometrics

Prof. Dan Longrois (Bichat Hospital, France) shares his insights on nociception monitoring and the innovative NOL technology developed by Medasense Biometrics.

What is nociception/anti nociception balance (NANB) monitoring and why do you think it’s important?

Selecting the safest form and dose of analgesia for an anesthetised patient is crucial for patient safety and comfort. In order to attain optimal analgesia, nociception – the physiological response to noxious stimuli – must be monitored. Nevertheless, nociception has largely been left to a certain level of guesswork and subjectivity by monitoring surrogate measures, such as heart rate and blood pressure, which are individually affected by physiological aspects unrelated to pain (e.g., hypercarbia, hypoxia and medications). Continuous nociception monitoring with high sensitivity and specificity can help the clinician achieve improved haemodynamic stability and smoother procedures.

How could better intraoperative NANB management help improve patient outcomes?

It has been reported for many years now that both excessive and insufficient doses/concentrations of opioids are associated with poor patient outcomes and extended postoperative recovery. Excessive doses of opioids, especially in the absence of nociceptive stimuli, can result in hypotension, hyperalgesia, respiratory depression and PONV. Insufficient opioids have been shown to result in hypertension, tachycardia and severe postoperative pain. Emerging evidence shows that some of the NANB monitors allow safe reduction of opioid use, resulting in more stable intraoperative blood pressure.

How does NOL technology contribute to nociception monitoring?

NOL technology objectively analyses multiple pain-related physiological parameters and derivatives through four sensors in a single finger probe. The validated NOL index enables titration of opioids based on numeric values, on a scale of 0 to 100, where 0 indicates no nociceptive response and 100 represents extreme nociceptive response.

I have observed that NOL values are more specific and sensitive than blood pressure and heart rate in response to a nociceptive stimulus, allowing more rapid evaluation of the NANB. NOL monitoring enables more personalised titration of opioids, even when administered by target-controlled infusion. Further outcome studies will be necessary, but the published results are encouraging. The era of personalised analgesia is here.

Medasense is bringing its NOL monitoring technology to Euroanaesthesia 2019 with a unique simulation hub at booth B-0405. Prof. Dan Longrois, clinical consultant to Medasense, will be a key speaker at Medasense’s NOL EXPLORE and User Group sessions at the conference. Attendees interested in learning more can register to the sessions here.