The Mind Prepared: Hypnosis in Surgery

Extract

In 1846, a Scottish surgeon named James Esdaile reported 80% surgical anesthesia using hypnosis as the sole anesthetic for amputations in India. His work caused sufficient stir that when ether anesthesia was demonstrated in what is now called the Ether Dome at the Massachusetts General Hospital on October 16 of that same year, a surgeon strode to the front of the amphitheater and said, “Gentlemen, this is no humbug,” to distinguish his surgical team's demonstration from Esdaile's report. It has taken us a century and a half to rediscover the fact that the mind has something to do with pain and can be a powerful tool in controlling it: the strain in pain lies mainly in the brain.

In this issue of the Journal, Montgomery et al. ( 1 ) report the results of a randomized trial conducted among 200 patients who underwent excisional breast biopsy or lumpectomy for breast cancer. Patients were assigned to either routine anesthesia plus nondirective empathic listening (the control condition) or a very brief 15-minute presurgery hypnosis session. The hypnosis, which the authors describe in very cursory fashion, consisted of “a relaxation-based induction (including imagery for muscle relaxation), suggestions for pleasant visual imagery, suggestions to experience relaxation and peace, specific symptom-focused suggestions (i.e., to experience reduced pain, nausea, and fatigue), a deepening procedure, and instructions for how patients could use hypnosis on their own following the intervention session.” This brief hypnotic preparation was sufficient to produce a statistically significant reduction in the use of propofol and lidocaine; yet despite this, patients in the intervention group reported less pain, nausea, fatigue, discomfort, and emotional upset than did patients in the control group. Doing good also meant doing well, in that the use of hypnosis also resulted in a cost savings of $772.71 per patient, due largely to shorter time in the operating room—an average of 10.6 minutes.