Integration of self-hypnosis in an enhanced recovery after surgery program in gynecologic oncology - A prospective randomized trial.

OBJECTIVE

To evaluate whether adding self-hypnosis (SH) to our enhanced recovery after surgery (ERAS) pathway was feasible and could improve patient-reported pain.

METHODS

Patients undergoing exploratory laparotomy were randomized to ERAS or ERAS+SH. Patients in the ERAS+SH arm were asked to listen a SH audio file in the preoperative holding area. Feasibility endpoint was defined as 60 % of patients listening to the audio in the preoperative holding area. Primary effectiveness outcome was patient-reported worst pain on postoperative day 1. Secondary outcomes included patient-reported anxiety, quality of life, symptom burden, time to first opioid, morphine equivalent daily dose after surgery, and satisfaction with the SH experience.

RESULTS

152 patients were randomized and 138 underwent open gynecologic surgery and were evaluable: 67 (48.6 %) to ERAS and 71 (51.4 %) to ERAS+SH. Incorporation of SH was considered feasible with 77.5 % of patients listening to the entire audio file in the holding area. The study was closed prematurely before achieving the N = 224 sample size due to futility in achieving the primary effectiveness outcome. There were no significant group differences in patient-reported worst pain on postoperative day 1, median morphine equivalents during admission or time to first opioid after surgery. In the ERAS+SH arm, there was a 2-point decrease (median score of 2; IQR 1-3; p < 0.001) in anxiety scores after the SH intervention. Median scores on satisfaction questions were 8/10 or above.

CONCLUSIONS

Incorporating SH to an ERAS pathway was feasible with high levels of satisfaction. While the SH intervention statistically and clinically significantly decreased self-reported anxiety, there was no improvement in self-reported pain, quality of life, time to first opioid, or opioid consumption during admission.