[Endocrine surgery by hypnosis. From fiction to daily clinical application...].
Between April 1994 and March 1996, 108 thyroidectomies (97 partial or unilateral lobectomies and 11 bilateral lobectomies) and 13 cervical explorations for hyperparathyroidism were performed under hypnosedation (HS) technique combining hypnosis and light conscious sedation. Informed consent was obtained from each patient. None of these patients underwent preoperatively standard susceptibility test score or preparatory hypnotic session. Nevertheless, no patient required conversion to general anesthesia. Operative data and postoperative courses were compared to a well-matched population (n = 70) of patients operated on for thyroid diseases under general anesthesia (GA). Under HS, mortality was zero and surgical management was only complicated by unilateral definitive recurrent laryngeal nerve paralysis in one case (0.8%) and the need for neck reexploration for severe hematoma after parathyroidectomy in another case. Hyperparathyroidism was cured in all cases. The surgeons all reported better operating conditions, estimated by visual analog scale (VAS), for cervicotomy using HS (8.9 +/- 0.6 cm vs 8.0 +/- 1.2 cm in the GA group, p < 0.01). This is probably related to reduced bleeding in the operative field. All the patients reported a very pleasant experience and enjoyed having their surgery performed under HS (VAS of satisfaction: 9.35 +/- 0.99 vs 2.88 cm +/- 2.8 cm in the GA group, p < 0.001). Patients having HS had less postoperative pain (VAS of pain: 2.2 +/- 1.6 cm vs 3.2 +/- 2.0 cm in the GA group, p < 0.01), whereas antalgic consumption was significantly reduced in the HS group compared with the GA group (paracetamol on first postoperative day was, 932 +/- 519 mg vs 1437 +/- 622 mg in the GA group, p < 0.001). Hospital stay was also significantly lower (46.3 h +/- 14.6 vs 74.2 +/- 9.5 h in the GA group, p < 0.001), providing a substantial reduction of the costs of medical care. The postoperative fatigue syndrome and surgical convalescence were significantly improved after HS (VAS of fatigue: 2.05 +/- 2.01 cm vs 4.7 +/- 2.4 cm in the GA group, p < 0.001, hand grip test: 95.5% of preoperative muscular maximum force vs 89.9% in the GA group, p < 0.01). Full return to social or professional activity was usually accomplished after 10.3 +/- 10.2 days in the HS group vs 36 +/- 8 days in the GA group, p < 0.001). From this study, we concluded that HS is a very effective technique for providing relief of intra- and postoperative pain in endocrine surgery. This technique results in high patient satisfaction and better surgical convalescence. This technique therefore can be used in most motivated patients and reduces the socio-economic impact of hospitalization.
Meurisse
M
M
Service de Chirurgie des Glandes Endocrines et Transplantation, Centre Hospitalier Universitaire de Liège, Belgique.
Faymonville
M E
ME
Joris
J
J
Nguyen Dang
D
D
Defechereux
T
T
Hamoir
E
E
D000203:Activities of Daily Living; D000328:Adult; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000601:surgery*; D006990:Hypnosis / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010147:Pain Measurement; D011184:Postoperative Period; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000523:psychology*; D013965:Thyroidectomy / Q000379:methods* / Q000534:rehabilitation
Chirurgie endocrinienne sous hypnose. De la fiction à l'application clinique quotidienne....