NOL Technology

Control pain. Avoid overdose. Eliminate doubt.

The NOL® Index

NOL (Nociception Level) is the technology and index developed by Medasense to objectively quantify a patient’s physiological pain response (nociception), enabling clinical teams to provide personalized pain treatment.

Medasense’s flagship product, PMD-200™ applies this technology in critical care settings to visualize pain response and personalize treatment. Recent evidence shows that NOL-guided surgery results in 33% less pain.1 Other studies have shown that NOL-guided analgesia reduces the risk of excessive use or underuse of opioids and associated complications.2

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Medasense is developing its pipeline products for clinics and home care, to lead pain prediction, stratification and prevention strategies.

Control Pain

Objectively measure pain and tailor analgesia dosing to each patient’s needs.

Avoid Overdose

Patients vary in their pain threshold and response to opioids.3 Avoiding excessive use of opioids can improve patient safety and outcomes.2

Eliminate Doubt

NOL monitoring enables confident assessment of the adequacy of pain treatment.

How It Works

The Physiological Principles Behind NOL

NOL is based on a proprietary, patented artificial intelligence technology that quantifies the individual physiological response to pain in real-time, continuously and noninvasively.

Activation of the sympathetic nervous system, as a result of multiple stimuli and inputs, leads to a constellation of nociception-related physiological responses, with complex inter-associations and different response profiles. Recognizing the complex nature of this process, the Nociception Level (NOL) index was developed as a multiparameter composite of autonomic signals.
Physiological principles behind NOL (Nociception Level) monitoring

Benefits

Shown to reduce reported pain scores in the PACU1
Reducing hypotension, improving haemodynamic stability and sparing opioids2
Potential cost savings within one year – and better use of healthcare resources4
Safe, noninvasive, continuous and simple to use

Testimonials

"As the doctor who headed the European Anesthesia Society, I am proud to see this groundbreaking development and to be among the first to use it."
Dr. Zeev Goldik, Head of Anesthesia, Intensive Care and Pain Medicine at Hacarmel Medical Center and former ESA President
Dr. Zeev Goldik, Head of Anesthesia, Intensive Care and Pain Medicine at Hacarmel Medical Center and former ESA President
"I see no way to perform surgery today without this technology"
Dr. Michael Grach, Department of Anesthesia and Respiratory Intensive Care, Carmel Hospital
Dr. Michael Grach, Department of Anesthesia and Respiratory Intensive Care, Carmel Hospital
"The NOL monitor adds information that improves my drug titration: I don’t give too much or too little – I can titrate my drugs to meet the patient’s needs."
Dr. Hugo Vereecke, Consultant Anesthetist, AZ Sint-Jan Brugge-Oostende AV, Belgium
Dr. Hugo Vereecke, Consultant Anesthetist, AZ Sint-Jan Brugge-Oostende AV, Belgium
"NOL technology gives us access to the most significant dimension in medicine and in anaesthesiology: Nociception and the effectiveness of anti-nociception interventions. This is a tool that can change clinical practice."
Prof. José Luiz Gomes do Amaral, Professor and Chairman, Department of Anesthesiology, Pain & Critical Care- Escola Paulista de Medicina, São Paulo, Brazil
Prof. José Luiz Gomes do Amaral, Professor and Chairman, Department of Anesthesiology, Pain & Critical Care- Escola Paulista de Medicina, São Paulo, Brazil
"It is clear that current pain assessment approaches in the operating room are limited. The NOL index provides anesthesiologists with a decision support tool to objectively assess and optimize the treatment of a patient’s nociception."
Prof. Albert Dahan, MD, PhD, Department of Anesthesiology, Leiden University Medical Center, The Netherlands
Prof. Albert Dahan, MD, PhD, Department of Anesthesiology, Leiden University Medical Center, The Netherlands
"As surgeons we have an interest in working along with nociception monitoring, as it enables us to learn a lot about our methods."
Dr. med. Thomas Kyriss, Surgeon, Department of General, Visceral and Pediatric Surgery, Klinikum Sindelfingen-Böblingen, Germany
Dr. med. Thomas Kyriss, Surgeon, Department of General, Visceral and Pediatric Surgery, Klinikum Sindelfingen-Böblingen, Germany
"Every individual has a different pain threshold and responds differently to pain medication. If we cannot monitor it effectively, how will we know?"
Professor Eyal Winkler, Director of the Department of Plastic Surgery at Mayanei Hayeshua Hospital. Head of the Winkler Clinic for Reconstructive Plastic Surgery and Anaesthetic Medicine
Professor Eyal Winkler, Director of the Department of Plastic Surgery at Mayanei Hayeshua Hospital. Head of the Winkler Clinic for Reconstructive Plastic Surgery and Anaesthetic Medicine
"I truly believe in the NOL technology. I am convinced it will improve the quality of our anesthesia and impact patient recovery."
Prof. Philippe Richebé, Professor and Anesthesiologist, Maisonneuve-Rosemont Hospital, University of Montreal, Quebec, Canada. Member of Medasense’s advisory board
Prof. Philippe Richebé, Professor and Anesthesiologist, Maisonneuve-Rosemont Hospital, University of Montreal, Quebec, Canada. Member of Medasense’s advisory board
"NOL provides additional and valuable information for clinical practice in anaesthesia. I have always wished for such a device."
Dr. med. Doreen Wiedemann, Department of Anesthesiology and Intensive Care, Otto-von-Guericke-Universität Magdeburg, Germany
Dr. med. Doreen Wiedemann, Department of Anesthesiology and Intensive Care, Otto-von-Guericke-Universität Magdeburg, Germany
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Video Highlights

Medasense - Our Vision: Guiding critical care clinicians for optimal pain care

Meeting the challenge of intraoperative pain monitoring

Leading clinicians on the importance of monitoring the patient’s pain response level

REFERENCES:
1. Meijer, F., Honing, M., Roor, T., Toet, S., Calis, P., Olofsen, E., Martini, C., van Velzen, M., Aarts, L., Niesters, M., Boon, M., Dahan, A. (2020). Reduced postoperative pain using Nociception Level-guided fentanyl dosing during sevoflurane anaesthesia: a randomised controlled trial. British Journal of Anaesthesia, 125(6), 1070-1078.
2. Meijer, F., Martini, C., Broens, S., Boon, M., Niesters, M., Aarts, L., Olofsen, E., van Velzen, M., Dahan, A. (2019). Nociception-guided versus Standard Care during Remifentanil–Propofol Anesthesia: A Randomized Controlled Trial. Anesthesiology, 130(5), 745-755. doi:10.1097/ALN.0000000000002634
3. Barash, Paul G.; Cullen, Bruce F.; Stoelting, Robert K.; Cahalan, Michael K.; Stock, M. Christine; Ortega, Rafael; Sharar, Sam R.; Holt, Natalie F. 2017. Clinical Anesthesia, 8th Ed. Lippincott Williams & Wilkins (LWW).
4. Saunders R., Weissbrod R. (2020). Cost benefit of personalizing intraoperative pain management. Presented at ISPOR Virtual Conference, May 2020.