Pre and Postoperative

Lancet. 1988 Aug 27;2(8609):491-3.

Improved recovery and reduced postoperative stay after therapeutic suggestions during general anesthesia.

Evans C, Richardson PH.

Department of Academic Psychiatry, United Medical School, Guy's Hospital, London.

The clinical value of therapeutic suggestions during general anaesthesia was assessed in a double-blind randomised placebo-controlled study. 39 unselected patients were allocated to suggestion (n = 19) or control (n = 20) groups who were played either recorded therapeutic suggestions or a blank tape, respectively, during hysterectomy. The patients in the suggestion group spent significantly less time in hospital after surgery, suffered from a significantly shorter period of pyrexia, and were generally rated by nurses as having made a better than expected recovery. Patients in the suggestion group, unlike those in the control group, guessed accurately that they had been played an instruction tape.

Am J Clin Hypn. 2003 Apr;45(4):333-51.

Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial.

Ginandes C, Brooks P, Sando W, Jones C, Aker J.

Department of Psychology, Harvard Medical School, McLean Hospital, 115 Mill Street Belmont, MA 02478, USA. carol_ginandes@hms.harvard.edu

Although medical hypnosis has a long history of myriad functional applications (pain reduction, procedural preparation etc.), it has been little tested for site-specific effects on physical healing per se. In this randomized controlled trial, we compared the relative efficacy of an adjunctive hypnotic intervention, supportive attention, and usual care only on early post-surgical wound healing. Eighteen healthy women presenting consecutively for medically recommended reduction mammaplasty at an ambulatory surgery practice underwent the same surgical protocol and postoperative care following preoperative randomization (n = 6 each) to one of the three treatment conditions: usual care, 8 adjunctive supportive attention sessions, or 8 adjunctive hypnosis sessions targeting accelerated wound healing. The primary outcome data of interest were objective, observational measures of incision healing made at 1,7 weeks postoperatively by medical staff blind to the participants' group assignments. Data included clinical exams and digitized photographs that were scored using a wound assessment inventory (WAI). Secondary outcome measures included the participants' subjectively rated pain, perceived incision healing (VAS Scales), and baseline and post-surgical functional health status (SF-36). Analysis of variance showed the hypnosis group's objectively observed wound healing to be significantly greater than the other two groups', p < .001, through 7 postoperative weeks; standard care controls showed the smallest degree of healing. In addition, at both the 1 and 7 week post-surgical observation intervals, one-way analyses showed the hypnosis group to be significantly more healed than the usual care controls, p < 0.02. The mean scores of the subjective assessments of postoperative pain, incision healing and functional recovery trended similarly. Results of this preliminary trial indicate that use of a targeted hypnotic intervention can accelerate postoperative wound healing and suggest that further tests of using hypnosis to augment physical healing are warranted.

Int J Clin Exp Hypn. 2002 Jan;50(1):17-32.

Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients.

Montgomery GH, Weltz CR, Seltz M, Bovbjerg DH.

Ruttenberg Cancer Center, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. guy.montgomery@mssm.edu

Each year, hundreds of thousands of women undergo excisional breast biopsies for definitive diagnosis. Not only do these patients experience pain associated with the procedure, but they also endure distress associated with the threat of cancer. Hypnosis has been demonstrated as effective for controlling patients' pain in other surgical settings, but breast surgery patients have received little attention. To determine the impact of brief presurgical hypnosis on these patients' postsurgery pain and distress and to explore possible mediating mechanisms of these effects, 20 excisional breast biopsy patients were randomly assigned to a hypnosis or control group (standard care). Hypnosis reduced postsurgery pain and distress. Initial evidence suggested that the effects of hypnosis were mediated by presurgery expectations.

Altern Ther Health Med. 1999 Mar;5(2):67-75.

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

Ginandes CS, Rosenthal DI.

Department of Psychiatry, Harvard Medical School, USA.

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 toward 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.

Obes Surg. 2001 Oct;11(5):589-93.

Assessment of the effects of a taped cognitive behavior message on postoperative complications (therapeutic suggestions under anesthesia).

Cowan GS Jr, Buffington CK, Cowan GS 3rd, Hathaway D.

Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. owcinc@mindspring.com

BACKGROUND: The authors studied whether playing a taped cognitive-behavior message during and immediately following bariatric surgery will improve performance of a postoperative regimen designed to enhance recovery. METHODS: The double-blinded placebo-controlled study consisted of 27 morbidly obese bariatric surgical patients randomly assigned to listen to either a blank (Controls) or a positive therapeutic message audiotape (Tape). A Postoperative Regimen Checklist (PRC) quantified different parts of the postoperative recovery regimen. RESULTS: The data showed that patients in the Tape group, compared to the Controls: 1) achieved better scores at most PRC assessment points (p < 0.05), 2) required less encouragement to perform tasks (p < 0.05), and 3) were discharged from the hospital a mean of 1.6 days earlier. CONCLUSIONS: A taped cognitive-behavioral message, played to patients repetitively during and immediately following bariatric surgery, is effective in enhancing postoperative compliance and reducing in-patient length of stay.

J Dev Behav Pediatr. 1996 Oct;17(5):307-10

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 44106, USA.

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 favorable 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.

Acta Anaesthesiol Scand. 1997 Sep;41(8):1028-32.

Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts. A prospective, randomized and blinded study.

Enqvist B, Bjorklund C, Engman M, Jakobsson J.

Dept. of Health Sciences, Karolinska Institute, Stockholm, Sweden.

BACKGROUND: Postoperative nausea and vomiting (PONV) after general anesthesia and surgery may have an incidence as high as 70% irrespective of antiemetic drug therapy. The use of preoperative hypnosis and mental preparation by means of an audio tape was investigated in the prophylaxis of nausea and vomiting before elective breast reduction surgery. Similar interventions have not been found in the literature. METHODS: Fifty women were randomized to a control group or a hypnosis group; the latter listened to an audio tape daily 4-6 days prior to surgery. A hypnotic induction was followed by suggestions as to how to relax and experience states incompatible with nausea and vomiting postoperatively (e.g. thirst and hunger). There was a training part on the tape where the patients were asked to rehearse their own model for stress reduction. Premedication and anesthetic procedures were standardized. RESULTS: Patients in the hypnosis group had significantly less vomiting, 39% compared to 68% in the control group, less nausea and less need of analgesics postoperatively. CONCLUSIONS: Preoperative relaxation and/or hypnotic techniques in breast surgery contribute to a reduction of both PONV and postoperative analgesic requirements

Acta Chir Belg. 1999 Aug;99(4):151-8.

Hypnosis with conscious sedation instead of general anaesthesia? Applications in cervical endocrine surgery.

Meurisse M, Defechereux T, Hamoir E, Maweja S, Marchettini P, Gollogly L, Degauque C, Joris J, Faymonville ME.

Department of Surgery, University of Liege, Belgium.

Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative courses of a closely-matched population (n = 121) of patients operated on under general anaesthesia (GA). Conversion from hypnosis to GA was needed in two cases (1%). All surgeons reported better operating conditions for cervicotomy using HYP. All patients having HYP reported a very pleasant experience and had significantly less postoperative pain while analgesic use was significantly reduced in this group. Hospital stay was also significantly shorter, providing a substantial reduction of the medical care costs. The postoperative convalescence was significantly improved after HYP and full return to social or professional activity was significantly shortened. We conclude that HYP is a very efficient technique providing physiological, psychological and economic benefits to the patient.

Anaesth Intensive Care. 2007 Oct;35(5):784-7.

Preoperative hypnotherapy in the management of a child with anticipatory nausea and vomiting.

Mackenzie A, Frawley GP.

Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia.

A six-year-old boy with oesophageal strictures secondary to neonatal repair of oesophageal atresia and requiring six to eight weekly oesophageal dilatations by bouginage developed anticipatory nausea and vomiting. This was effectively managed by a course of preoperative hypnotherapy over four sessions. Resolution of anticipatory nausea and vomiting occurred along with cessation of postoperative nausea and vomiting. This case supports early intervention with preoperative hypnotherapy in children with anticipatory nausea and vomiting that has not responded to other measures.

PMID: 17933170 [PubMed - indexed for MEDLINE]