A new European study using hypnosis in combination with local anesthesia (LA) for certain types of surgery found the the paired approach aided healing, reduced drug usage and allowed an earlier hospital discharge.
The combination could also help avoid cancer recurrence and metastases, said the researchers.
Drs. Fabienne Roelants and Christine Watremez 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 all of these procedures local anesthesia is feasible but not, on its own, sufficient to ensure patient comfort,” said Roelants.
In the first study, 18 women out of 78 had hypnosis for a number of breast cancer surgical procedures – partial mastectomy, node biopsy and axillary dissection – while the rest had general anesthetic (GA) for the same operations.
Although the patients who were hypnotized spent a few minutes more in the operating theater, opioid drug use in the first group was greatly diminished, as was time in the recovery room and hospital stay.
In the thyroid study, the researchers compared the outcomes of 18 patients in the LA/hypnosis group with 36 who had GA. Both groups had video-assisted thyroidectomy, in an attempt to decrease the invasiveness of the procedure without reducing patient comfort.
Once again, drug use, recovery room and hospital stay times were greatly reduced among the LA/hypnosis group.
“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,” said Roelants.
“Together with other anesthesiologists at the hospital, we are specialized in hypnosis,” said 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.
“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 said.
That point may be eye fixation, progressive muscle relaxation, or the retrieval of a pleasant memory.
That hypnosis works in reducing the perception of pain has been shown by a number of studies, including by imaging the brain with position emission tomography (PET). Similar effects have been shown by using functional magnetic resonance imaging (MRI). Exactly how hypnosis works in this respect is still under discussion.
“There is still a lot of debate around the exact mechanism that allows hypnosis to reduce pain perception,” said Roelants,”but what it absolutely clear is that it does so. The result is that one third of thyroidectomies and a quarter of all breast cancer surgery carried out at the UCL hospital are performed under local anaesthetic with the patient under hypnosis.”
There are no gender or age differences relating to susceptibility to hypnosis, the researchers say. If the patient is motivated, ready to co-operate, and trusts the doctors, hypnosis will work.
In addition to use in breast cancer surgery and thyroidectomy, the practice can be used in a number of other surgical procedures, for example carotid artery surgery, inguinal hernia, knee arthroscopy, gynaecological surgery, ophthalmology, ear nose and throat, plastic surgery and egg retrieval for fertility treatment.
“We believe 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.”
Watremez believes the use of hypnosis should spread as it is a nonpharmacological, noninvasive intervention that is an effective method to maximize outcomes and hopes the sharing of her research will “encourage others to carry out this procedure to the advantage of all concerned,” Watremez said.
The findings of the study were presented at the European Anesthesiology Congress in Amsterdam.