Research: Hypno-Anesthesia

Here are just a few relevant links, and I encourage you to do your own searches on the Internet to learn more.

Real World Use: Belgium

In an operating theatre in the Saint Luc University hospital in Brussels, the anaesthetist is also a hypnotist. Belgium is in the forefront of using hypnosis for surgery. 

Compared to general anaesthetic, post-op comfort is greater; people who have been under hypnosis feel more normal; scar-healing goes better, and less pain medication is needed.



Real World Use: Britain

In 2006, the a live television broadcast in the UK showed a man having a tumour surgically removed from his stomach without the use of any pain removing drugs whatsoever. Only hypno-anesthesia was use.

Click here to watch the programme in full. 


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A study featured in This Month in Anesthesiology showed that hypnosis, combined with slight conscious intravenous sedation (hypnosedation) and local anesthesia, offers a valuable alternative to traditional general anesthesia.1–4 In our center, the technique has been used in more than 1,800 surgical interventions since 1992. The effectiveness of hypnosis in producing analgesia has been demonstrated by two clinical studies.

 

Summaries of Various Studies

 

Adjunctive Non-Pharmacological Analgesia for Invasive Medical Procedures: A Randomised Trial

Elvira V Lang, Eric G Benotsch, Lauri J Fick, Susan Lutgendorf, Michael L Berbaum, Kevin S Berbaum, Henrietta Logan, David Spiegel.

The Lancet, Vol 355, April 29, 2000, pages 1486-1490.

Background

Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study.

Hypnosis had more profound effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.
Elvira V Lang et al

Methods

241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 minutes during and after the procedures.

Findings

Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of 0.04 (standard), -0.07 (attention), and 0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 minutes) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min).

Interpretation

Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more profound effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.

Self-hypnotic relaxation can reduce drug use and improve procedural safety.

Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use.

Lang EV, Joyce JS, Spiegel D, Hamilton D, Lee KK. Department of Veterans Affairs Medical Center (DVAMC), Palo Alto, California

International Journal of Clinical and Experimental Hypnosis 1996 Apr; 44(2):106-19

The authors evaluated whether self-hypnotic relaxation can reduce the need for intravenous conscious sedation during interventional radiological procedures. Sixteen patients were randomized to a test group, and 14 patients were randomized to a control group. All had patient-controlled analgesia. Test patients additionally had self-hypnotic relaxation and underwent a Hypnotic Induction Profile test.

Compared to controls, test patients used less drugs (0.28 vs. 2.01 drug units; P< 0.01) and reported less pain (median pain rating 2 vs. 5 on a 0-10 scale; P<0.01). Significantly more control patients exhibited oxygen desaturation and/or needed interruptions of their procedures for hemodynamic instability. Benefit did not correlate with hypnotizability.

Self-hypnotic relaxation can reduce drug use and improve procedural safety.

Significantly lower postoperative pain ratings and shorter hospital stays occurred for children in the experimental group. State anxiety was also decreased for the guided imagery group

The effects of hypnosis/guided imagery on the postoperative course of children.

Lambert SA. University Hospitals of Cleveland, Rainbow babies and Children’s Hospital, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.

Journal of Developmental and Behavioural Pediatrics 1996 Oct; 17(5):307-10

Hypnosis, guided imagery and relaxation have been shown to improve the postoperative course of adult surgical patients. Children have successfully used hypnosis/guided imagery to significantly reduce the pain associated with invasive procedures and to improve selected medical conditions. The purpose of this study was to examine the effect of hypnosis/guided imagery on the postoperative course of pediatric surgical patients.

Fifty-two children (matched for sex, age and diagnosis) were randomly assigned to an experimental or control group. The experimental group was taught guided imagery by the investigator. Practice of the imagery technique included suggestions for a favourable postoperative course.

Significantly lower postoperative pain ratings and shorter hospital stays occurred for children in the experimental group. State anxiety was decreased for the guided imagery group and increased postoperatively for the control group.

This study demonstrates the positive effects of hypnosis/guided imagery for the pediatric surgical patient.

It is a simple and effective method which does not require any preparation...spares the need for a harmacological sedation and obviates the possible hazards of such a sedation.

Hypnotic technique for sedation of patients during upper gastro-intestinal endoscopy.

Zimmerman J. Gastroenterology Unit, Hadassah University Hospital, Jerusalem, Israel.

American Journal of Clinical Hypnosis 1998 Apr; 40(4):284-7

A method of sedation of patients undergoing gastrointestinal endoscopy is described. This technique employs a variety of elements, including “pacing and leading,” metaphors, use of psychological reactions to deepen the relaxation, imagery and post hypnotic suggestions. It is a simple and effective method which does not require any preparation. It spares the need for a pharmacological sedation and obviates the possible hazards of such a sedation. The author has successfully used this technique to sedate more than 200 patients undergoing upper gastrointestinal endoscopy. The duration of examinations performed this way compares with that using conventional pharmacology sedation. However, unlike the case of pharmacological sedation, no further monitoring is needed after the completion of the examination and the patients can leave the clinic immediately to resume their activities.

Hypnosis can diminish pain and anxiety for many emergency patients during examinations and procedures

Hypnosis for pediatric fracture reduction

Iserson KV. Arizona Bioethics Programs and Section of Emergency Medicine, University of Arizona, Tucson

Journal of Emergency Medicine 1999 Jan-Feb; 17(1):53-6 

Hypnosis can diminish pain and anxiety for many emergency patients during examinations and procedures. While hypnosis has been used for millenia and was demonstrated to be of use in clinical medicine more than a century ago, modern physicians have been reluctant to adopt this technique in clinical practice.
This article describes four children with angulated forearm fractures who had no possible access to other forms of analgesia during reduction, and in whom hypnosis was used successfully. A simple method for hypnotic induction is described.

hypnosis may be capable of enhancing both anatomical and functional fracture healing

Using hypnosis to accelerate the healing of bone fractures: a randomized controlled pilot study.

Ginandes CS, Rosenthal DI. Department of Psychiatry, Harvard Medical School.

Alternative Therapies in Health and Medicine 1999 Mar; 5(2):67-75

CONTEXT: Hypnosis has been used in numerous medical applications for functional and psychological improvement, but has been inadequately tested for anatomical healing.
OBJECTIVE: To determine whether a hypnotic intervention accelerates bodily tissue healing using bone fracture healing as a site-specific test.

DESIGN: Randomized controlled pilot study.
SETTING: Massachusetts General Hospital, Boston, Mass and McLean Hospital, Belmont, Mass.

PATIENTS: Twelve healthy adult subjects with the study fracture were recruited from an orthopedic emergency department and randomized to either a treatment (n=6) or a control group (n=6). One subject, randomized to the treatment group, withdrew prior to the intervention.

INTERVENTION: All 11 subjects received standard orthopedic care including serial radiographs and clinical assessments through 12 weeks following injury. The treatment group received a hypnotic intervention (individual sessions, audiotapes) designed to augment fracture healing.

MAIN OUTCOME MEASURES: Radiological and orthopedic assessments of fracture healing 12 weeks following injury and hypnotic subjects’ final questionnaires and test scores on the Hypnotic Induction Scale.

RESULTS: Results showed trends toward faster healing for the hypnosis group through week 9 following injury. Objective radiographic outcome data revealed a notable difference in fracture edge healing at 6 weeks. Orthopedic assessments showing trends toward better healing for hypnosis subjects through week 9 included improved ankle mobility, greater functional ability to descend stairs, lower use of analgesics in weeks 1, 3, and 9; and trends towards lower self-reported pain through 6 weeks.

CONCLUSION: Despite a small sample size and limited statistical power, these data suggest that hypnosis may be capable of enhancing both anatomical and functional fracture healing, and that further investigation of hypnosis to accelerate healing is warranted.

No conversion to general anesthesia was needed. No complications were observed. All the patients were cured with a mean follow-up of 18 +/- 12 months

Bilateral neck exploration under hypnosedation: a new standard of care in primary hyperparathyroidism?

Meurisse M, Hamoir E, Defechereux T, Gollogly L, Derry O, Postal A, Joris J, Faymonville ME.

epartment of Surgery, University of Liege,Belguim Annals of Surgery 1999 Mar; 229(3):401-8

OBJECTIVE: The authors review their experience with initial bilateral neck exploration under local anesthesia and hypnosedation for primary hyperparathyroidism. Efficacy, safety and cost effectiveness of this new approach are examined.

BACKGROUND: Standard bilateral parathyroid exploration under general anesthesia is associated with significant risk, especially in an elderly population. Image-guided unilateral approaches, although theoretically less invasive, expose the patients to the potential risk of missing multiple adenomas or asymmetric hyperplasia. Initial bilateral neck exploration under hypnosedation may maximize the strengths of both approaches while minimizing their weaknesses.

METHODS: In a consecutive series of 121 initial cervicotomies for primary hyperparathyroidism performed between 1995 and 1997, 31 patients were selected on the basis of their own request to undergo a conventional bilateral neck exploration under local anesthesia and hypnosedation. Neither preoperative testing of hypnotic susceptibility nor expensive localization studies were done. A hypnotic state (immobility, subjective well-being, and increased pain thresholds) were induced within 10 minutes; restoration of a fully conscious state was obtained within several seconds. Patient comfort and quiet surgical conditions were ensured by local anesthesia of the collar incision and minimal intravenous sedation titrated throughout the surgery. Both peri- and postoperative records were examined to assess the safety and efficacy of this new approach.

RESULTS: No conversion to general anesthesia was needed. No complications were observed. All the patients were cured with a mean follow-up of 18 +/- 12 months. Mean operating time was < 1 hour. Four glands were identified in 84% of cases, three glands in 9.7%. Adenomas were found in 26 cases; among these, 6 were ectopic. Hyperplasia, requiring subtotal parathyroidectomy and transcervical thymectomy, was found in five cases (16.1%), all of which had gone undetected by localization studies when requested by the referring physician. Concomitant thyroid lobectomy was performed in four cases. Patient comfort and recovery and surgical conditions were evaluated on visual analog scales as excellent. Postoperative analgesic consumption was minimal. Mean length of hospital stay was 1.5 +/- 0.5 days.

CONCLUSIONS: Initial bilateral neck exploration for primary hyperparathyroidism can be performed safely, efficiently and cost-effectively under hypnosedation, which may therefore be proposed as a new standard of care.

results suggest that a brief hypnosis intervention may reduce orthopedic hand-surgery patients’ postsurgical PPI, PPA and anxiety; decrease comorbidity; and enhance postsurgical recovery and rehabilitation

Medical hypnosis and orthopedic hand surgery: pain perception, postoperative recovery and therapeutic comfort.

Mauer MH, Burnett KF, Ouellette EA, Ironson GH, Dandes HM. University of Miami, Coral Gables, Florida. International

Journal of Clinical and Experimental Hypnosis 1999 Apr; 47(2):144-61

Orthopedic hand-surgery patients experience severe pain post-operatively, yet they must engage in painful exercises and wound care shortly after surgery; poor patient involvement may result in loss of function and disfigurement. This study tested a hypnosis intervention designed to reduce pain perception, enhance postsurgical recovery, and facilitate rehabilitation.

Using a quasi-experimental design, 60 hand-surgery patients received either usual treatment or usual treatment plus hypnosis. After controlling for gender, race and pretreatment scores, the hypnosis group showed significant decreases in measures of perceived pain intensity (PPI), perceived pain affect (PPA) and state anxiety. In addition, physician’s ratings of progress were significantly higher for experimental subjects than for controls, and the experimental group had significantly fewer medical complications.
These results suggest that a brief hypnosis intervention may reduce orthopedic hand-surgery patients’ postsurgical PPI, PPA and anxiety; decrease comorbidity; and enhance postsurgical recovery and rehabilitation. However, true experimental research designs with other types of controls must be employed to determine more fully the contribution of hypnosis to improved outcome.