A meta-analysis of mind–body interventions and surgery included 191 studies and more than 8,600 patients. The use of mind–body approaches, including such interventions as hypnosis, imagery, and relaxation, was associated with reduced blood loss, decreased pain, decreased medication use, increased return of bowel function, decreased psychological stress, and decreased hospital stay by 1.5 days. In a study of 241 patients undergoing invasive medical procedures randomized to standard care versus structured attention versus self-hypnosis, the hypnosis has the most pronounced effects on pain and anxiety and improved hemodynamic stability (122). In a study designed to examine the impact of preoperative instructions, patients undergoing spinal procedures involving fusions or instrumentation (surgeries associated with significant blood loss) were enrolled. All subjects received a 15-minute interaction with a psychologist. The subjects were randomized into one of three groups receiving either direct simple information alone, information plus instruction in muscle relaxation, or information plus instruction in previsualization of the blood moving away from the surgical site during surgery. Controlling for the length of surgery and incision length, the estimated blood loss in the first two groups averaged 900 mL and in the third group was 500 mL (123).
In a study of ambulatory surgery patients receiving spinal anesthesia, patients who were randomized to listening to soothing music had decreased sedative requirements both during the surgery and in the perioperative period (124). Patients undergoing cataract surgery were randomized to receive a 5-minute hand massage preoperatively or to the control group. When compared with the control group, the intervention group had significantly decreased levels of anxiety, systolic blood pressure, diastolic blood pressure, heart rate, and epinephrine and norepinephrine (125).
In a study of women undergoing hysterectomy, patients received standardized anesthesia and were randomized to music during surgery, music plus positive suggestions, or the sounds of the operating room. On the day of surgery, both the music group and the music-plus-suggestion groups received significantly less rescue anesthesia. On postoperative day 1, the patients who had heard music during surgery had more effective analgesia and early mobilization. At the time of discharge, both intervention groups had less fatigue. There was no change in nausea and vomiting, bowel function, or length of stay (126).
In another study with patients undergoing abdominal hysterectomy, patients were randomized to listen intraoperatively to one of four tapes: positive suggestions regarding pain, or nausea and vomiting, or both, or white noise. The positive suggestions had no beneficial effects in reducing nausea and vomiting or the consumption of analgesics or antiemetics (127). In another randomized controlled trial in patients undergoing thyroidectomy under general anesthesia, patients were randomized to listen to taped positive suggestions during surgery versus a blank tape. The group receiving the suggestions had less nausea and vomiting (47% vs. 85%), and less antiemetic treatment (30% vs. 68%) (128). In a study exploring the timing of listening to taped suggestions, patients who received the suggestions preoperatively had a 30% decrease in estimated blood loss. Patients receiving the suggestions both pre-and perioperatively had a 26% decrease in blood loss, and in the group listening to the suggestions only intraoperatively, there was a 9% decrease in blood loss. The authors suggest that the preoperative suggestions may be the critical factor (129).
In a retrospective study examining the use of hypnosis plus conscious sedation for plastic surgery, the patients who received hypnosis had better pain and anxiety relief, decreased nausea and vomiting, and a significant reduction in midazolam and alfentanil requirements and patient satisfaction was significantly increased (130).
Although the studies and interventions in mind–body approaches in the surgical patient are varied, these interventions are low cost and low risk and may offer very real benefits for the patient, as well as a greater sense of empowerment.