Analgesia Adjunta no farmacologica para procedimientos médicos invasores

Analgesia Adjunta no farmacológica para procedimientos médicos invasores: Hipnosis. Un Ensayo Seleccionado al Azar.

Lancet 2000; 355: 1486­90

Investigadores norteamericanos le han hallado a la hipnosis una nueva utilidad terapéutica: la reducción del dolor que experimentan quienes son sometidos a intervenciones quirúrgicas.

Un reciente estudio publicado en The Lancet agrega una nueva utilidad a la técnica de  hipnosis: según un trabajo dirigido por la doctora Elvira Lang, investigadora del Centro Médico Beth Israel, de Boston, Estados Unidos, la hipnosis o hipnoterapia permite reducir el dolor durante una intervención quirúrgica. La experiencia fue realizada en 241 pacientes que fueron sometidos a cirugías sin anestesia general; a quienes les fue adeministrada hipnosis antes de entrar al quirófano.

Requirieron menos medicación analgésica, salieron del quirófano más rápido e incluso sus signos vitales se mantuvieron más estables durante la intervención.

Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial

Lancet 2000; 355: 1486­90
Elvira V Lang, Eric G Benotsch, Lauri J Fick, Susan Lutgendorf,
Michael L Berbaum, Kevin S Berbaum, Henrietta Logan, David Spiegel

Fuente The Lancet
Lancet 2000; 355: 1486­90

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Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial

Lancet 2000; 355: 1486­90
Elvira V Lang, Eric G Benotsch, Lauri J Fick, Susan Lutgendorf,
Michael L Berbaum, Kevin S Berbaum, Henrietta Logan, David Spiegel

Beth Israel Deaconess Medical Center/Harvard Medical School (E V Lang MD);

Department of Radiology, Boston, MA (E V Lang), University of Iowa, Iowa City, IA; Departments of Radiology (E V Lang, E G Benotsch PhD, L J Fick BS, K S Berbaum PhD), Psychology (S Lutendorf PhD), Division of Public Health Services and Research,

University of Florida, Gainsville, FL (H Logan PhD); Institute for Social Science Research, University of Alabama, Tuscaloosa, AL (M L Berbaum PhD); and Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA (D Spiegel PhD), USA

Summary

Background Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study.

Methods 241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0­10 scales before, every 15 min during and after the procedures.

Findings Pain increased linearly with procedure time in the standard group (slope 0·09 in pain score/15 min, p<0·0001), and the attention group (slope 0·04/15 min; p=0·0425), but remained flat in the hypnosis group.

Anxiety decreased over time in all three groups with slopes of -0·04 (standard), -0·07 (attention), and -0·11 (hypnosis). Drug use in the standard group (1·9 units) was significantly higher than in the attention and hypnosis groups (0·8 and 0·9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0·0041), and 12 standard patients (p=0·0009).

Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0·0016) with procedure duration of the attention group in between (67 min).

Interpretation Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.

FUENTE The Lancet Lancet 2000; 355: 1486­90