Hypnosis Has Benefits in Breast and Thyroid Surgery

June 14, 2011 — For certain types of breast and thyroid surgery, a combination of hypnosis and local anesthesia is feasible, can aid in the healing process, and can reduce drug use and time spent in the hospital, according to 2 studies reported at Euroanaesthesia 2011: the European Anaesthesiology Congress in Amsterdam, the Netherlands.

Fabienne Roelants, MD, and Christine Watremez, MD, from the Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain in Brussels, Belgium, reported their group's experience with hypnosis and local anesthesia in certain breast surgeries and video-assisted thyroidectomy.

In the breast surgery study, the clinicians took a look back at 78 women who underwent quadrantectomy and sentinel node biopsy or axillary dissection under hypnosis and local anesthesia (n = 18) or under general anesthesia (n = 60) between January and October 2010.

Hypnosis was induced using standard progressive muscle relaxation hypnotic techniques, described by Milton H. Erickson, MD, the American psychiatrist who pioneered medical hypnosis. Hypnosis was initiated in the operating room at the time of local anesthesia and continued throughout the surgery.

Local anesthesia was performed by the surgeon (lidocaine 0.5% plus levobupivacaine 0.25%). A continuous infusion of remifentanil (0.05 μg/kg per min) was increased as needed. In the general anesthesia group, anesthesia was induced with propofol, ketamine, clonidine, lidocaine, and sufentanil.

According to the researchers, there was no difference in length of surgery in the 2 groups. Although women who were hypnotized spent a few minutes more in the operating room (122 vs 116 min), perioperative drug use was reduced, as was time in the recovery room and in the hospital. No patient in the hypnosis group converted to general anesthesia during surgery.

Table 1: Comparative Results for Key Outcomes After Breast Surgery

Variable	Hypnosis + Local Anesthesia	General Anesthesia	P value
Operative time (min)	81	80.5	ns
Time spent in operating room	122	116	ns
Ephedrine use (mg)	0	6	.001
Recovery room paracetamol use	0.33	0.05	.004
Recovery room piritramide use	1.78	3.83	.02
Hospital stay (days)	2.38	3.1	.004

ns = not significant

There was also less fluid drainage in the hypnosis group (24.7 vs 61.4 mL; P = .02), which the researchers say "may be the result of posthypnotic suggestion."

"Being able to avoid general anesthesia in breast cancer surgery is important," Dr. Roelants said, "because we know that local anesthesia can block the body's stress response to surgery and could, therefore, reduce the possible spread of metastases."

Hypnosis for Video-Assisted Thyroidectomy

Dr. Roelants and Dr. Watremez have had similar success using hypnosis and local anesthesia in patients undergoing video-assisted thyroidectomy. In their second study presented at the meeting, hypnosis was induced with a combination of standard eye fixation and progressive muscle relaxation hypnotic techniques, also using the Erickson approach. The use of local and general anesthesia in this study mirrored that in the breast surgery study.

The clinicians report that drug use and length of stay in the recovery room and hospital were lower in the 18 patients who underwent the surgery after hypnosis and local anesthesia than in the 36 patients who received general anesthesia.

Table 2: Comparative Results for Key Outcomes After Thyroidectomy

Variable	Hypnosis + Local Anesthesia	General Anesthesia
Operative time (min)	109*	91
Time spent in operating room	148	144
Ephedrine use (mg)	0*	5.4
Time in recovery (min)	89*	134
Hospital stay >1 day (n)	0 of 18*	14 of 36

*P < .05

There was less nausea with hypnosis, the researchers say, and no difference in pain scores in the recovery room. Patient satisfaction scores were higher in the hypnosis group, and no one in the hypnosis group converted to general anesthesia during surgery.

Hypnosis "Flat Out Works"

In all the surgeries studied, "local anesthesia is feasible but not, on its own, sufficient to ensure patient comfort," Dr. Roelants noted in a statement from the meeting.

"This is not the first study using hypnosis in thyroidectomy patients, but it is the first study using hypnosis for video-assisted thyroidectomy," Dr. Roelants and Dr. Watremez noted in an interview to Medscape Medical News.

"It takes special training in hypnotic techniques, especially the techniques that reduce anxiety and pain. In our hospital, almost half of our staff will be trained in hypnosis at the end of this year," they said.

Reached by telephone for comment, Guy H. Montgomery, MD, from Mount Sinai School of Medicine in New York City, said that these 2 studies appear to be "strong" and provide more data that hypnosis can be effective in surgery.

"Hypnosis for surgery has been around since before ether. There are meta-analyses on the use of hypnosis in surgical patients, and the effect sizes are typically large. It's one of the areas where it just flat out works," he said.

Dr. Montgomery was not involved in the 2 studies, but has conducted research on hypnosis. A study of his published last year looked at the underlying mechanisms responsible for hypnotic effects in breast surgery patients (J Consult Clin Psychol. 2010;78:80-88).

"We found that for pain reduction, things like changing your expectation and reducing stress are huge in terms of accounting for how hypnosis works," he said.

The study investigators and Dr. Montgomery have disclosed no relevant financial relationships.

Euroanaesthesia 2011: the European Anaesthesiology Congress. Abstracts 8AP5-4 and 8AP5-8. Presented June 12, 2011.

Reference:- http://www.medscape.com/viewarticle/744526