Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients

Breast cancer surgery is associated with side effects, including postsurgical pain, nausea, and fatigue. We carried out a randomized clinical trial to test the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective.

We randomly assigned 200 patients who were scheduled to undergo excisional breast biopsy or lumpectomy (mean age 48.5 years) to a 15-minute presurgery hypnosis session conducted by a psychologist or nondirective empathic listening (attention control). Patients were not blinded to group assignment. Intraoperative anesthesia use (i.e., of the analgesics lidocaine and fentanyl and the sedatives propofol and midazolam) was assessed. Patient-reported pain and other side effects as measured on a visual analog scale (0–100) were assessed at discharge, as was use of analgesics in the recovery room. Institutional costs and time in the operating room were assessed via chart review.

Patients in the hypnosis group required less propofol (means = 64.01 versus 96.64 µg; difference = 32.63; 95% confidence interval [CI] = 3.95 to 61.30) and lidocaine (means = 24.23 versus 31.09 mL; difference = 6.86; 95% CI = 3.05 to 10.68) than patients in the control group. Patients in the hypnosis group also reported less pain intensity (means = 22.43 versus 47.83; difference = 25.40; 95% CI = 17.56 to 33.25), pain unpleasantness (means = 21.19 versus 39.05; difference = 17.86; 95% CI = 9.92 to 25.80), nausea (means = 6.57 versus 25.49; difference = 18.92; 95% CI = 12.98 to 24.87), fatigue (means = 29.47 versus 54.20; difference = 24.73; 95% CI = 16.64 to 32.83), discomfort (means = 23.01 versus 43.20; difference = 20.19; 95% CI = 12.36 to 28.02), and emotional upset (means = 8.67 versus 33.46; difference = 24.79; 95% CI = 18.56 to 31.03). No statistically significant differences were seen in the use of fentanyl, midazolam, or recovery room analgesics. Institutional costs for surgical breast cancer procedures were $8561 per patient at Mount Sinai School of Medicine. Patients in the hypnosis group cost the institution $772.71 less per patient than those in the control group (95% CI = 75.10 to 1469.89), mainly due to reduced surgical time.

Hypnosis was superior to attention control regarding propofol and lidocaine use; pain, nausea, fatigue, discomfort, and emotional upset at discharge; and institutional cost. Overall, the present data support the use of hypnosis with breast cancer surgery patients.

Prior knowledge

Hypnosis has been shown to reduce the need for medication and postsurgical symptoms in some surgical populations, but its effectiveness in breast cancer patients undergoing surgery was not known.

Study design

Randomized trial in which use of anesthesia during surgery and patient-reported postsurgical pain and other side effects were compared in women who were randomly assigned to a brief psychologist-conducted hypnosis intervention before excisional tumor biopsy or lumpectomy or to a control (nondirected listening) session with a psychologist. Institutional costs of surgery were also compared between the groups.

Contribution

Patients in the hypnosis group required less of the analgesic lidocaine and the sedative propofol during surgery than patients in the control group; they also reported less postsurgical pain and other side effects and spent less time in surgery. Surgical costs were also lower in the hypnosis group.

Implications

The hypnosis intervention not only reduced use of anesthesia and self-reported pain but also reduced institutional costs for surgery, mainly by reducing time in the operating room.

Limitations

Patients were not blinded to their group assignment, and the effectiveness of blinding of the research and clinical staff was not formally assessed. Whether the hypnosis intervention would be effective if administered by nonpsychologists was not evaluated.