Hypnosis for Postoperative Pain Management of Thoracoscopic Approach to Repair Pectus Excavatum: Retrospective Analysis

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Abstract

Introduction

Nuss procedure, a minimally invasive thoracoscopic approach to repair pectus excavatum, results in a smaller scar but significant pain. The purpose of this Institutional Review Board-approved retrospective study was to compare postoperative pain management outcomes of adolescents who self-selected to receive or not receive preoperative self-hypnosis training before Nuss procedure. Self-hypnosis, an integrative medicine approach to pain management, may be more effective than traditional analgesics alone for managing postoperative pain.

Methods

In 2011, 8 of 22 patients who underwent Nuss procedure received preoperative self-hypnosis training and postoperative self-hypnosis coaching. Postoperatively, patients received epidural analgesia with local anesthetic, intravenous patient-controlled opioid analgesia, and intravenous nonsteroidal anti-inflammatory drugs and transitioned to oral opioids and nonsteroidal anti-inflammatory drugs.

Results

Self-hypnosis training was associated with use of fewer milligrams per hour of morphine equivalents (p = .005) and lower mean pain intensity over the first 5 days of hospital stay (p = .041). Despite the opioid-sparing effect of self-hypnosis training, nausea, vomiting, constipation, and hypoventilation were adverse effects experienced by patients in both groups.

Discussion

The results of this retrospective study suggest that self-hypnosis provides an opioid-sparing effect for managing moderate-to-severe pediatric postoperative pain after Nuss procedure. Further clinical studies are needed to validate the effectiveness of self-hypnosis for symptom management after painful pediatric surgical procedures.

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