Preparing Patients for Surgery Hypnotically

1. Preparing Patients for Surgery Hypnotically • Linda Thomson, APRN, ABMH • Hypnovations III - Intermediate Workshop • Burlington, VT • April 2010 1

2. Objectives • Summarize research on adjunctive hypnosis with surgery patients • Discuss effective hypnotic techniques to use pre-operatively, intra-operatively and post-operatively 2

3. Historically • 1840s – Esdaille used mesmerization • 1846 – ether • 1847 - chloroform 3

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5. Ingredients for Anxiety in the OR • Masked strangers • Loss of control • Uncertainty of outcome • Fear of pain, life, health, complications • Immobilization • Darkness or bright spot lights • Hospital “johnny” • Scary equipment 5

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7. Surgery is a traumatic injury that stimulates the stress response. 7

8. Stress delays wound healing and surgical recovery • Glaser, et al. 1999 Archives of General Psychiatry 8

9. Hypnosis can mitigate the stress response. 9

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12. We strive to achieve iatrogenic health with words that heal. • Milton Erickson 12

13. Words are the most powerful drugs used by mankind. • Rudyard Kipling 13

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15. Surgical patients given – Pre-operative information, psychological support or hypnosis • Recovered more rapidly physically • Felt better psychologically • 2.4 days shorter hospital stay • Mumford (1982) Amer. J. of Public Health 15

16. Pre-surgical Psychological intervention • Shorter hospital stay • Less narcotic use • Less post-op pain • Less post-op anxiety • Less blood loss • Earlier return of GI function • Blankfield (1991) AJCH 16

17. Adjunctive Hypnosis with surgical patients • Patients in the hypnosis groups had better outcomes than 89% of patients in control groups • Montgomery (2002) Anesthesia & Analgesia 17

18. Ways Hypnosis can be effective in surgery • Potentiates the effects of analgesics and anesthesia • Facilitates post-op healing • Helps maintain stability of vital signs • Peebles-Kleiger • Emer. Med Clin of NA, 2000 18

19. 4 th Use of Hypnosis in Surgery • Sole anesthetic for surgery 19

20. Hypnosis plus conscious sedationinstead of general anesthesia • 1,650 surgical cases • Hypnosis patients compared to standard anesthesia patients • greater comfort and active participation • faster recovery • shorter hospital stays • Faymonville, 1999 20

21. Review of the Literature • Lang et al: 241 patients undergoing vascular and renal procedures • Patients randomly assigned to one of 3 groups • Standard care group • Structured attention group • Self-hypnotic relaxation group 21

22. Review of the Literature • All patients had patient controlled analgesia (PCA) • Pain was rated on a visual analog scale every 15 minutes during and after the procedure. • Lang et. al. 22

23. Results regarding pain • Standard care group used 1.9 units • Structured attention group used 0.8 units • Hypnosis group used 0.9 units • Lang, et al 23

24. Results regarding hemodynamic stability • 12 unstable patients in standard group • 10 unstable patients in structured attention • 1 unstable patient in hypnosis group • Lang, et al 24

25. Self-Hypnotic Relaxation • Reduced pain • Lessened need for medication • Decreased anxiety • Greater hemodynamic stability • Lang, et al (2000) Lancet 25

26. Review of the Literature • Cost Effectiveness Study • Lang and Rosen did cost analysis with adjunct hypnosis with sedation during interventional radiology procedures • Standard sedation cost $638 per case • Hypnosis/Sedation patient cost $300 per case 26

27. Cost analysis of adjunct hypnosis • Cost savings of $338/case with hypnosis • Hypnosis has been shown to reduce room time in interventional radiologic procedures • HOWEVER, even if 58.2 minutes were added to room time, it would still be cost effective! • Lang & Rosen, Radiology, 2002 27

28. Review of the Literature • Meta-analysis by Montgomery et al regarding hypnotically induced analgesia to see how effective hypnosis was for women undergoing excisional breast biopsy in regards to pain and anxiety. 28

29. Review of the Literature • Results • Hypnotized group had significantly less pain (p=0.001) • Hypnotized group had significantly less anxiety (p=0.025) • Montgomery 29

30. Review of the Literature • Eberhart et al Double-blind randomized study of 100 patients undergoing thyroidectomy. Divided in two groups: • One group had hypnotic suggestion audiotape playing during the surgery • Control group had a blank tape playing during the surgery 30

31. Review of the Literature • Results • Hypnotic suggestion group had less nausea • 47.2% compared to control group at 85.7% • Hypnotic group required less anti-emetics • 30.6% compared to control group at 68.6% • Eberhart et al 31

32. Review of the Literature • Enquist et al did a prospective randomized and blinded study using preoperative hypnosis to reduce postoperative vomiting in 50 women undergoing breast surgery • 2 groups • Control group with standard care • Treatment group that listened to audiotape • 4-6 days prior to surgery 32

33. Review of the Literature • Results • Hypnotized group had significantly less vomiting at 39% compared to 68% • Hypnotized group reported less nausea • Hypnotized group required less analgesia • Enqvist et al 33

34. Post-Surgical Wound Healing • Hypnosis group showed significant difference (p<.001) • greater degree of healing at 1 and 7 weeks • Less post-operative pain • Improved functional recovery • Ginandes, et al 2003 AJCH 34

35. Hypnosis with Pediatric Surgical PatientsLambert, JDBP, 1996 35

36. Patient’s overall recovery from surgery is only partially related to his physical state and significantly related to psychological factors • Kessler (1996) Int J Clin Exp Hypn • Mumford (1982) AM J Public Health • Blankfield (1991) AJCH • Kinsman (1977) Psychosom Med • Volicier (1977) Nursing Research 36

37. Hypnotically Prepared Surgical Patients • Reduced acute distress and pain • Ameliorate effects of analgesia & anesthesia • Stabilize vital signs • Reduce complications • Fewer post-op side effects • Reduced post-op nausea and vomiting • Facilitate healing and recovery • Reduce health care costs 37

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40. History (while building rapport) • What is the surgery? • When? • Where? • Who is performing the surgery? • Why are they having the surgery? • How will life be better after the surgery? 40

41. History (while building rapport) • Previous experience with surgery, hospitalization, medication, anesthesia, needles, etc Any problems? • Concerns, worries, fears • Previous experience with hypnosis, guided imagery, meditation • Any other medical conditions? • Anesthesia 41

42. History (while building rapport) • Coping Strategies • Active vs. passive • Attender vs. Avoider • Expected post-op course • Anything else 42

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44. History (while building rapport) • Spouse, significant other • Children • Career, school, employment, responsibilities 44

45. History (while building rapport) • Safe Place Imagery • Problems with stairs, escalators, elevators 45

46. History (while building rapport) • God? • Music? 46

47. Script • Ego strengthening – tap into inner strength • Induction • Deepening • Safe Place • Personalize • God’s presence (or not) 47

48. Script • Further deepening • Suggestion for warmth • Words that you need most to hear • Getting rid of unwanted worries or thoughts • Use interruptions for fractionation • Pay attention only when spoken to • Scripture (or not) 48

49. Script • Prepare for equipment • Anesthesia • Constricting blood vessels • Homeostasis • Surgery will go exactly as planned • Personalize • Healing can begin • Empowering 49

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