Thanks to anesthesia, most surgical patients are unconscious and therefore unaware of any pain their bodies are experiencing.
However, the body still senses the stimuli that would cause pain and responds to it involuntarily.
This response is callednociception.
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We know people respond to painful signals even if theyre not conscious.
Everyone is at risk of having pain during surgery.
Even small operations cause plenty of pain.
Your body may react to painful sensations by increasing your heart rate or blood pressure or by sweating.
You may also move involuntarily.
Because these reactions may be subtle, its possible for anesthesiologists to miss certain pain signals.
A new gadget is helping anesthesiologists more precisely identify and respond to pain during surgery.
The NOL index is a scale of 0-to-100 (no pain to extreme pain).
The target NOL score for a patient under anesthesia is around 25.
How Do Anesthesiologists Treat Pain?
Anesthesia providers typically use two classes of medications during surgery: anesthetics and analgesics.
Anesthetics are medications that keep you unconscious during surgery.
Analgesics, or painkillers, ease any pain your body may sense during and after the operation.
Its currently authorized for use during operations to help personalize analgesia dosing to the patients actual requirement.
It is not yet authorized to treat or monitor post-op pain.
In the United States, theFDA recently granted de novo classification to the PM-200.
Controlling Pain During Surgery Impacts Recovery, Too
Pain management during surgery is just the beginning.
Not having enough pain medication during surgery can mean worsepain after surgery.
Patients under anesthesia still have physiological pain.
Once the patient becomes conscious again, they will feel the pain.
This can cause oversedation, delirium, or confusion.
Pain control during surgery is a balance between anesthesia and analgesia.
Will NOL Monitoring During Surgery Become Standard?
There are some limitations to the PMD-200.
Clinical trials have not consistently shown that NOL monitoring during surgery reduces short-term or long-term pain for patients.
More research would be needed before NOL monitoring could become the standard of care.
There also have not been many studies, and more are clearly needed.
We have an opioid epidemic.
We dont want to use more opioids than necessary, especially if we do not see their benefits.
We saw NOL monitoring used in critical care during COVID, Zuckerman Stark said.
Critical care patients are sedated just like surgery patients, but for days or weeks.
We were concerned to see the amounts of opioids patients in the ICU were receiving over time.
Eventually, NOL could even be useful outside of the hospital.
It could also be used to better respond to chronic pain.
What This Means For You
Researchers are exploring new ways to monitor pain during and after surgery.
If youll be having surgery, talk to your provider about how your pain will be managed.
While medications can be effective, they have risks.
There are also non-medication ways to manage pain after surgery that may help.
Medasense Biometrics.Introducing the NOL (nociception level) index algorithm: a technical overview.
