MedicalResearch.com Interview with:
Dr Emmanuel Boselli, MD, PhD
Anesthesiology and Intensive Care
University Claude Bernard Lyon I
University of Lyon
Medical Research: What is the background for this study? What are the main findings?
Dr. Boselli: We hypothesized that the use of conversational hypnosis in patients undergoing regional anesthesia procedures for ambulatory upper limb surgery might provide better comfort than the use of oral premedication during the regional anesthesia procedure. We assessed the subjective effect of conversational hypnosis on a patient self-reported comfort scale ranging from 0 (no comfort) to 10 (maximal comfort), and the objective effect was assessed using the Analgesia/Nociception Index (ANI), a 0-100 index derived from heart rate variability reflecting the relative parasympathetic tone. In our study of 100 patients undergoing hand surgery in two different centers, 50 had conversational hypnosis while being given regional anesthesia (Saint-Grégoire hospital), and 50 were given of oral hydroxyzine 30 minutes to an hour before the regional anesthesia procedure (Lyon hospital). Patients having hypnosis measured an average ANI of 51 before and 78 after hypnosis, whereas those who had premedication averaged 63 before and 70 after. The average comfort scale of those who had received hypnosis was 6.7 before and 9.3 after, while patients who had medication averaged 7.8 before and 8.3 after. The main finding of this study is that conversational hypnosis induced greater increase in comfort scales and ANI values than oral premedication.
Medical Research: What is conversational hypnosis? What does it consist of?
Dr. Boselli: Conversational hypnosis consists of matching the patient’s behavioral communication patterns, reflective listening, avoiding any negative suggestion (e.g. “Keep calm and quiet” instead of “Please don’t move!”) and focalizing the patient’s attention on something else than the regional anesthesia procedure, such as the ultrasound machine screen.
Medical Research: Who does it (the anesthesiologist, nurse, etc.)? And how does it work? How long does it take?
Dr. Boselli: In this study, it was performed by the anesthesiologist, but nurses may also use it. The focalization on something else than the regional anesthesia procedure and the use of calm and positive words divert the patients’ attention and therefore induce better comfort. It’s like giving a tablet to a noisy children at the rear of the car for him to play and bear this so long and unpleasant trip. It takes no additional time, just the time of the regional anesthesia procedure. It is just a change in the way the physician interacts with the patient.
Medical Research: Could it be readily used prior to surgery and could it be applied to other types of surgery and prior to other types of anesthesia?
Dr. Boselli: It may be used readily prior to surgery and may be applied to any type of surgery. Conversational hypnosis may only be used in conscious patients, i.e. during local or regional anesthesia. It may also be used before general anesthesia, to decrease the patient anxiety.
Medical Research: Is hydroxyzine prior to anesthesia in ambulatory hand surgery the standard of care to relax the patients before receiving anesthesia?
Dr. Boselli: The use of premedication with various drugs (hydroxyzine, alprazolam…) differs widely from one center to another, and its usefulness is currently a matter of debate. In our study, hydroxyzine is the standard of care as premedication to relax prior to anesthesia in the center where patients have no hypnosis (Lyon hospital), but in the other center (Saint-Grégoire hospital), the standard of care is to give no premedication and to use conversational hypnosis.
Medical Research: The abstract mentions that hypnosis has been shown to reduce preoperative anxiety in adult patients. What new information does your study provide?
Dr. Boselli: The new information is that hypnosis during regional anesthesia increases subjective comfort (higher self reported 0-10 comfort scale in comparison with no hypnosis), but also, and this is the main part, that an objective measurement of this increased comfort can be performed using ANI: patients with hypnosis have higher ANI values than patients with no hypnosis. The clinical impact of this finding is now to be determined.
Medical Research: Can you explain ANI (Analgesia/Nociception Index) in lay terms?
Dr. Boselli: In lay terms, imagine that wellbeing is like a yin/yang balance. This yin/yang balance is the analgesia/nociception balance, mediated by the sympathetic and the parasympathetic systems regulating the nervous system. The sympathetic system is activated during stress, anxiety, or pain. It is responsible for example for the acceleration of heart rate, the increase in blood pressure and even for the pupil dilation, which is a protective action to prepare the organism to run away from the danger, like when you meet a bear or a lion in the dark. The parasympathetic system is activated when you are relaxed, calm. It is responsible for the decrease in heart rate or blood pressure. Imagine a yogi during meditation. The ANI reflects the relative part of the “zen” system in the regulation of the nervous system. If you are totally relaxed, painless and comfortable, then the ANI is 100 because you have maximal parasympathetic tone (and null sympathetic tone). If you are saving your life running away from the lion or the bear in the dark, then you have maximal stress, with maximal sympathetic tone (and null parasympathetic tone), then the ANI is 0.
Medical Research: What should clinicians and patients take away from your report? What recommendations do you have for future research as a result of this study?
Dr. Boselli: Clinical hypnosis has recently regained popularity among healthcare providers, in particular anesthesiologists. The objective assessment of the effects of hypnosis on anxiety or pain is a new and exciting field of research to provide a scientific rationale for the widespread use and development of hypnosis inside the operating room by clinicians to improve patient comfort.
Boselli E, Musellec H, Bernard F, Augris-Mathieu C, Bouvet L, Diot-Junique N, Guillou N, Hugot P, Allaouchiche B. Assessment of the objective effect using Analgesia/Nociception Index (ANI) and subjective effect using a self-reported comfort scale of conversational hypnosis during axillary blocks in adults: a quasiexperimental study. Abstract A4066, ASA 2015, San Diego, CA.
Dr Emmanuel Boselli, MD, PhD (2015). Soothing words do more than pills to calm anxious patients