Hypnosis/Local Anesthesia Combination During Surgery Helps Patients Heal Faster, And Reduces Hospital Stays
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Anaesthesiologists have found that by using a combination of hypnosis and local anaesthesia (LA) for certain types of surgery, the healing process is aided, and there is a reduction of drug use and time spent in hospital. And, according to new research to be presented at the European Anaesthesiology Congress in Amsterdam, the combination could also help avoid cancer recurrence and metastases.
"In all of these procedures local anaesthesia is feasible but not, on its own, sufficient to ensure patient comfort," says Professor Fabienne Roelants, who with Dr. Christine Watremez from the Department of Anaesthesiology at the Cliniques Universitaires St. Luc, UCL, Brussels, Belgium, studied the impact of using LA and hypnosis in certain kinds of breast cancer surgery and in thyroidectomy (removal of all or part of the thyroid gland).
In the first study, 18 women out of 78 had hypnosis for a number of breast cancer surgical procedures -- quadrantectomy (partial mastectomy), sentinel node biopsy (examination of the first lymph node or group of lymph nodes likely to be reached by metastasizing cancer cells) and axillary dissection (opening the armpit to examine or remove some or all of the lymph nodes) -- while the rest had general anaesthetic (GA) or the same operations. Opioid drug use in the first group was greatly diminished, as was time in the recovery room and hospital stay, although the hypnotized patients spent a few more minutes in the operating theatre.
In the thyroid study, the researchers compared the outcomes of 18 patients in the LA/hypnosis group with 36 who had GA. In an attempt to decrease the invasiveness of the procedure without reducing patient comfort, both groups had video-assisted thyroidectomy. Once again, among the LA/hypnosis group, drug use, recovery room and hospital stay times were greatly reduced
"In addition to reducing drug use and hospital stay time, being able to avoid general anesthesia in breast cancer surgery is important because we know that local anesthesia can block the body's stress response to surgery and could therefore reduce the possible spread of metastases," Professor Roelants notes.
"Together, with other anesthesiologists at the hospital, we are specialized in hypnosis," says Dr. Watremez. "Although there are special precautions to be taken -- for example, only the hypnotherapist should talk to the patient during the procedure and should avoid negatives, which unconsciousness cannot handle, and the surgeon needs to be gentle, avoid any tugging in his movements, and be able to remain cool in all circumstances -- it is a straightforward procedure and appreciated by the patients.”
She continues, "Imagine you are driving your car. You suddenly realize how far you have driven, but for a long time your mind has been elsewhere. This is extremely common, and is nothing more nor less than a mild hypnotic trance -- a modified state of consciousness, with a different perception of the world. The principle of hypnosis is to focus one's attention on one particular point," she says.
That point may be eye fixation, progressive muscle relaxation, or the retrieval of a pleasant memory. A number of studies have shown that hypnosis works in reducing the perception of pain by including imaging the brain with position emission tomography (PET). Functional magnetic resonance imaging (MRIs) have shown similar effects. Still under discussion is exactly how hypnosis works in this respect. Some researchers believe that it permits a better response to pain by activating pain-inhibiting paths more effectively. Others believe it prevents information from reaching the higher cortical regions that are responsible for the perception of pain.
Professor Roelants states, "There is still a lot of debate around the exact mechanism that allows hypnosis to reduce pain perception, but what it absolutely clear is that it does so. The result,” he explains, “is that one third of thyroidectomies and a quarter of all breast cancer surgery carried out at the UCL hospital is performed under local anesthetic with the patient under hypnosis."
The researchers say there are no sex or age differences relating to susceptibility to hypnosis.
Hypnosis will work If the patient trusts the doctors, is motivated, and ready to cooperate. The practice can be used in a number of other surgical procedures in addition to use in breast cancer surgery and thyroidectomy; they include carotid artery surgery, inguinal hernia, knee arthroscopy, gynecological surgery, ophthalmology, ear nose and throat, plastic surgery and egg retrieval for fertility treatment.
"We believe,” concludes Dr. Watremez, “that our studies have shown considerable benefits for the LA/hypnosis combination, and that such benefits are not only for patients, but also for healthcare systems. By using hypnosis combined with LA we can reduce the costs involved in longer hospital stays, remove the need for patients to use opioid drugs, and increase their overall comfort and satisfaction levels. To date there are few publications about the use of hypnosis in surgery, and we hope that, by contributing to the body of evidence on its efficacy, our research will encourage others to carry out this procedure to the advantage of all concerned.”
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Source:
European Society of Anaesthesiology (2011, June 13). Hypnosis/local anesthesia combination during surgery helps patients, reduces hospital stays, study finds.
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