The Application Of Hypnotism In The Surgery Of Local Anesthesia

Objective:To study the application of hypnotism in local anesthesia,and to explore its safety and feasibility;To prove that hypnotism can effectively assist local anesthesia,achieve satisfactory effect and improve the comfort of anesthesia.Methods:The study was informed to all patients and approved by the Ethics Committee of Tianjin Medical University Cancer Institute&Hospital.From August 2017 to June 2019,patients,all were willing to receive hypnosis treatment and were susceptible to hypnosis,were selected for breast tumor resection.According to the Stanford Hypnotic Susceptibility Scale,the patients were selected as ASA Ⅰ-Ⅱ,their breast tumor was determined by type-B ultrasonic as T1 stage,and they are all right handed.Before operation,200 patients were selected according to the experimental conditions,and evenly and randomly divided into hypnotic experimental group(H Group)and experimental control group(N Group).One day before the operation,anesthesiologists visited two groups of patients.For the patients in N Group,anesthesiologists visited preoperatively to understand their basic situation.For the patients in group H,besides routine preoperative visiting,anesthesiologists made psychological intervention and explained the process of hypnosis to make them understand the safety and reliability of hypnosis.The four time points of data collection are:the time when the patients entered the room(TO),5 minutes after the operation(T1),the time when the operation is finished(T2),and the time when the next day’s postoperative return visit(T3).On the day of operation,the two groups of patients were monitored to understand their vital signs and bispectral index(BIS).Local infiltration anesthesia was performed in both groups.For H Group,anesthetists performed local infiltration anesthesia,and hypnotized them to a certain depth of hypnosis;For N group,anesthetists performed local infiltration anesthesia directly.Patients in both groups were performed breast resection after local infiltration anesthesia.Blood pressure(BP),heart rate(HR)and BIS of both groups were observed and recorded at T0,T1 and T2 respectively.Their SpO2 was monitored during the whole operation,and the lowest SpO2 for both groups was recorded.The venous blood of both groups at T0 and T2 was extracted,and the plasma cortisol(COR)and blood glucose(Glu)levels of the two groups were measured after operation.At T1,the anesthesiologist observed the patient’s facial expression by faces pain Scale-Revised(FPS-R),evaluated their pain,and recorded the scores.At the postoperative visit,the patients were asked to use Visual Analog Scale(VAS)and Comfort Scale(BCS)to score the intraoperative pain and comfort,and record the scores.The experimental data were collected for statistical analysis.Results:The following results were obtained from the experimental data:(1)There was no significant difference in blood pressure,heart rate,BIS value,Cor and Glu level between the two groups at T1.There is no statistical significance.(2)The values of blood pressure,heart rate and BIS in H Group were lower than those in N Group at T1 and T2.The difference was statistically significant(P<0.05).(3)The blood pressure,heart rate and BIS of H Group at T1 and T2 were lower than those of H Group at T0.The difference was statistically significant(P<0.05).(4)The blood pressure and heart rate of N group at Tl and T2 were higher than those of N group at T0.The difference was statistically significant(P<0.05).(5)The score of FPS-R at T1 in H Group was Lower than that in N Group.The difference was statistically significant(P<0.05).(6)At T2,the levels of Cor and Glu in the plasma of patients in H Group were lower than those in N Group.The difference was statistically significant(P<0.05).(7)The level of Cor and Glu in blood of N Group at T2 was higher than that of N group at T0.The difference was statistically significant(P<0.05).(8)The level of Cor and Glu in blood of H Group at T2 was higher than that at T0.The difference was statistically significant(P<0.05).(9)At T3,the VAS score of H Group was lower than that of N Group.The difference was statistically significant(P<0.05).(10)At T3,BCS scores for patients in H Group were higher than those for N Group.The difference was statistically significant(P<0.05).(11)During the whole operation,the lowest SpO2 of the two groups was within the normal range,and there was no hypoxia.Conclusion:Local infiltration anesthesia is simple,safe,and effective,but it can not block the tactile traction and make patients fully awake.It can stimulate the patients to have a series of stress reactions,such as the increase of blood pressure and heart rate,stimulation of sympathetic nerve,improvement of cortisol secretion,and increase of the risk of cardiovascular complications.Hypnosis combined with local infiltration anesthesia can play an auxiliary role in analgesia,and make patients mildly sedated,effectively inhibit the physiological and psychological stress reactions caused by surgical stimulation,reduce the incidence of adverse reactions during operation,improve the comfort of patients,and reduce the occurrence of psychological adverse reactions caused by surgery.