Sola C, Devigne J, Bringuier S, el al.
British Journal of Anaesthesia 2023, 132 (3) 314-21. https://doi.org/10.1016/j.bja.2022.11.023
Aim of Study
To compare the impact of general anaesthesia (GA) and intraoperative hypnosis on the postoperative recovery and patient experience in paediatric superficial surgery.
Design and Location
Prospective randomised controlled study. Conducted at the paediatric anaesthesia and critical care unit of the Montpellier University Hospital, France.
Methodology
Between July 2015 and January 2018, 111 patients were assessed for eligibility. 51 were excluded. Of those 25 were excluded for not meeting the inclusion criteria and 26 declined to participate. 60 patients were randomised into either the GA or hypnosis group using computer-generated randomisation with age-stratification (ages 7-11 and 12-16).
30 patients received GA. 30 patients were allocated to the hypnosis group. Of those, 29 received the allocated intervention and 1 received GA due to unexpected surgical difficulty.
Primary Outcome
Length of hospital stay, defined as the time from anaesthesia or hypnosis induction to hospital discharge.
Secondary Outcomes
Length of stay in the PACU and preoperative anxiety level assessed in children by the short version of the modified Yale Preoperative Anxiety Scale (mYPAS)10 and in both parents and children using a VAS (VAS-anxiety).
Statistics
An intention-to-treat analysis was performed and statistical analysis was performed. A P-value of <0.05 was considered significant.
Results
2 children in the GA group were lost to follow up.
3 children in the hypnosis group required NO to deepen hypnotic trance and 1 child required GA due to unexpected difficulty in surgery.
Primary outcome – the average length of hospital stay was significantly shorter in the hypnosis group (P<0.001). The median time was 120 minutes in the hypnosis group vs 240 minutes in GA group.
Secondary outcomes – the hypnosis group had significantly shorter stay in PACU (P<0.001), reported lower levels of pre operative anxiety (P=0.001) and there was no significant difference in post-operative pain measured between groups.
Conclusions/Discussions
Hypnosis is shown to be associated with reduced pre-op anxiety and reducing length of hospital stay and PACU stay in children undergoing short (<60min) superficial surgery.
Stated Limitations from the Study
- Inclusion criteria age limits to children aged 7-16
- A significant proportion of eligible patients declined to participate.
- Because patients/families were informed of allocation, could introduced bias in pre-op anxiety scores.
- The inclusion period was longer than expected due to limited availability of healthcare professionals trained in use of hyponosis.
- Clinicians were not blinded which can introduce performance bias.
- Mono-centric, subject to local organisation constraints.
Discussion from Journal Club Meeting (?Change of Practice)
Patients in the hypnosis group, received topical EMLA cream on the surgical site 40 minutes prior to the procedure which the GA group did not. This could be a confounder.
Application to KH relies on provision of funding, training and uptake of hypnosis for clinicians. Additionally, paediatric superficial surgery is not routinely performed at KHFT.
Summary by Dr E Evans, Journal Club Meeting 23 March 2023.
KingstonGasDocs 