It sounds like something from the 1840s: a patient awake on the operating table, calm, absorbed in a pleasant memory while a surgeon removes their thyroid. In fact it happens routinely in a modern university hospital, and has done for more than thirty years.
Hypnosedation
The technique is called hypnosedation. It was introduced in 1992 by the anaesthetist Marie-Elisabeth Faymonville at the University Hospital of Liège in Belgium. It combines three things:
- Hypnosis, guided by the anaesthetist throughout the operation
- Local anaesthetic at the site of surgery
- Light intravenous sedation and pain relief, in small doses, as needed
The patient remains conscious and able to speak, but their attention is elsewhere, usually reliving a holiday or another enjoyable experience of their own choosing. A full anaesthetic team is present, and a general anaesthetic can be given at any moment if needed.
The Liège team has reported using it in thousands of operations, most often on the thyroid and for removal of breast lumps.
What they report
Compared with standard approaches, the Liège studies describe:
- Less anxiety and pain during the operation
- Lower doses of sedative and pain-relieving drugs
- Good operating conditions for the surgeon
- Less pain and fatigue afterwards
- Faster recovery and return to normal activity
Hypnosis before surgery
You do not need to stay awake to benefit. In a well-known American trial led by Guy Montgomery, 200 women about to have a breast biopsy or lumpectomy were given either a 15-minute hypnosis session with a psychologist shortly before surgery, or 15 minutes of supportive listening.
The hypnosis group needed less of the anaesthetic drug propofol and less local anaesthetic. They reported less pain, nausea, fatigue and discomfort afterwards. Their operations were also slightly shorter, and the researchers estimated a saving of about $770 per patient.
Wider reviews of hypnosis around surgery have reached similar conclusions: benefits for pain, anxiety, medication use and recovery.
How can it work?
- Attention. Pain needs attention. Deep absorption in something else leaves less of it available.
- Anxiety. Fear amplifies pain and raises the amount of medication needed. Hypnosis lowers it.
- Expectation. Suggestions of comfort and quick healing shape what the patient experiences.
- Brain processing. Imaging studies from Liège and elsewhere show hypnosis changing activity in brain regions involved in the experience of pain.
What it is not
- Not hypnosis alone. Local anaesthetic does the main work of blocking pain at the wound. Hypnosis handles the rest of the experience.
- Not for every operation. It suits procedures that can be done under local anaesthetic. Major abdominal or chest surgery still needs a general anaesthetic.
- Not for every patient. The patient must be willing and able to cooperate. It is not suitable for everyone, and not everyone responds.
- Not do-it-yourself. It is delivered by trained anaesthetists in a fully equipped theatre.
Where else hypnosis is used in hospitals
- Biopsies and radiology procedures
- Dental surgery
- Burn dressing changes
- Endoscopy
- Children’s procedures
- Labour
If you are facing surgery
- Ask whether your hospital offers hypnosis or relaxation support. Availability varies a great deal.
- Use a recording in the days before. Preparation for surgery recordings are widely available.
- Tell your anaesthetist about your worries. Reducing fear is part of their job.
- Practise slow breathing and a calm-place image to use while you wait.
- Never avoid a recommended anaesthetic on the strength of an article. Discuss your options with the team.
The bottom line
Hypnosis in surgery is not a stunt. In the right operations and with the right team, it reduces drugs, discomfort and recovery time.
Next in the series: Hypnosis for Public Speaking: Calm Nerves and Confident Delivery
This article is for general information and is not medical advice. Decisions about anaesthesia should be made with your surgical team.