At this year’s largest conference on anaesthesia, a new topic was up for discussion: Not using general anaesthesia. Rather than making surgical patients unconscious, doctors at the Institut Curie in Paris have regularly been using hypnosis to help conscious patients withstand the pain of surgery.
At the 2018 Euroanaesthesia conference in Copenhagen, Denmark this week, a team of researchers presented an evaluation of 150 surgeries performed on cancer patients between 2011 and 2017, which relied on hypnosis. In 99% of cases, they found, the method worked absolutely fine. Two patients experienced discomfort at the beginning of surgery, but doctors were able to easily convert to general anaesthesia in less than three minutes.
Doctors didn’t use hypnosis as the sole form of pain management. Instead, they used a technique called “hypnosedation,” which combines hypnosis with drugs (anti-nausea drugs, an opioid called remifentanil, and further painkillers) to help sedate the patient and keep them relaxed while conscious, as well as a local anaesthesia to prevent local pain. Some 90% of the surgeries in the study were for breast cancer (many were mastectomies), while the remaining 10% included gynaecological surgeries, colonoscopies, and plastic surgeries. On average, these surgeries lasted about 60 minutes, all of which the patients got through on hypnosedation.
Aurore Marcou, an anesthesiologist at the Institut Curie and lead author of the study, explains that fMRI scans show hypnosis affects the cerebral mode of the brain. “The physiological state is associated with heightened receptivity for suggestions and ability to modulate the sensory perceptions,” she writes in an email. Doctors can effectively use hypnosis to get patients to disassociate from the nervous system’s response to harm. “Suggestions of analgesia [the inability to feel pain] lead to a higher pain threshold and decrease in subjective pain intensity as well as pain unpleasantness,” she adds.
Previous clinical studies have shown that hypnosedation doesn’t work in 1%-2% of cases, notes Marcou, a figure that’s supported by her research. However, the high success rate of hypnosedation in clinical studies suggests maintaining consciousness under hypnosis is a viable alternative to general anaesthesia for most people. Patients who used hypnosedation have a quicker recovery time than those under general anaesthesia, and also avoided anaesthesia side effects, “including throat pains, nausea, vomiting, fatigue, cognitive disorders,” notes Marcou. This makes it especially interesting for elderly patients or those with severe cardiac or respiratory who can suffer especially bad side effects.
Hypnosedation isn’t exactly rare—Marcou says the University Hospital Center at Liège in Belgium has reported more than 12,000 cases where hypnosis was used to treat pain since 1992—but, as practitioners have to be experts in both anaesthesia and hypnosis, it’s still fairly unusual. There are plenty of people who might still choose the risk of myriad anaesthesia side effects over staying conscious during surgery but, for those brave enough to face it, hypnosis is far more robust than its snake-charmer connotations would suggest.