Suggestions During Anesthesia May Reduce Pain, Opioid Use After Surgery

By Lisa Rapaport

December 16, 2020

(Reuters Health) - Patients who heard therapeutic suggestions during surgery requiring general anesthesia experienced significantly less pain and used less opioids after surgery, a clinical trial found.

Researchers randomly assigned 385 patients undergoing surgery under general anesthesia for 1 to 3 hours 1:1 to receive hypnotherapy-like therapeutic suggestions with an audiotape of pleasant background music and soothing words or a control group with a blank tape playing during surgery. Overall, fewer people in the hypnotherapy group needed postoperative opioids (63%) than in the control group (80%).

People who received suggestions during surgery also had a significantly smaller median opioid dose within the first 24 hours after surgery (4.0 mg morphine equivalents) than the control group (5.3 mg morphine equivalents).

Both groups reported similar pain levels prior to surgery. However, pain scores in the first 24 hours after surgery were 25% lower, on average, among the patients in the suggestions group, according to the report in The BMJ.

"This study demonstrated positive therapeutic suggestions provided while patients are under general anesthesia have an amazing impact on post-surgical pain and recovery," said Gary Elkins, a professor in the department of psychology and neuroscience and director of the Mind-Body Medicine Research Laboratory at Baylor University in Waco, Texas.

"Notably, in this clinical study patients wore headphones, which excluded unintended distractions while the patients were provided very positive and reassuring therapeutic suggestions for comfort, well-being, and self-healing," Elkins, who wasn't involved in the study, said by email. "It is likely that patients responded to these suggestions by experiencing greater comfort and well-being post-surgery and therefore required less opioid analgesic medications."

Participants were slightly younger in the intervention group (median age 52 years) than the control group (median age 54 years) but were similar in type and duration of surgery, pre-operative pain, and use of drugs during surgery.

For the therapeutic suggestion intervention, patients wore headphones and heard an audiotape that played background music and positive suggestions for 20 minutes, followed by 10 minutes of silence, on repeat the entire time they were under general anesthesia. In the control group, patients also wore headphones while under anesthesia, but they were played a blank tape.

The study team developed the recorded suggestions, which were based on hypnotherapeutic principles and dealt with topics such as competence and care of the surgical and anesthesiology team, pain regulation, dissociation to a safe place, affirmation, anxiety control, and confidence, according to the report.

There were no adverse events associated with the intervention, and researchers calculated a number needed to treat of 6 to avoid use of postoperative opioids.

Participants underwent a wide range of surgical procedures including operations for the thyroid gland, abdominal hernia, spine, cholecystectomy, laparoscopy, hysterectomy, colorectal operations, adrenalectomy, fundoplication, and pelvic floor repair.

One limitation of the study is the inability to determine whether background music, rather than the therapeutic suggestions, might have been responsible for any effect on pain or opioid use, the study team notes. It's also possible that simply blocking out other sounds of the operating suite with headphones might have a therapeutic effect, independent of any music or therapeutic spoken recordings.

The authors were not available to comment by press time.

"Unfortunately, this study design cannot disentangle the effects of the suggestions from the effects of music on postoperative pain and opioid outcomes," said Eric Garland, director of the Center on Mindfulness and Integrative Health Intervention Development at the University of Utah in Salt Lake City.

Even so, results from this trial and others demonstrate that use of therapeutic suggestions during surgery improves postoperative outcomes, Garland, who wasn't involved in the study, said by email.

"Given the efficacy, safety, and low cost of this adjunctive approach, clinicians should use therapeutic suggestions as part of standard care during surgical procedures," Garland advised.

SOURCE: The BMJ, online December 15, 2020.