Effectiveness of hypnoanalgesia for dermatological surgery in children: Randomised clinical trial

Abstract

Background and Objective. Diagnostic or therapeutic procedures may generate pain, fear or anxiety. The aim of this paper is to assess whether hypnosedation in children undergoing dermatological surgery is effective in reducing the doses of sedation and analgesia during the periprocedure. Patients and methods. Clinical trial in which paediatric patients scheduled for removal of benign skin lesions in a hospital were randomised to receive hypnosis (intervention group) or attention-distracting techniques (control group). The outcome measures used were doses of sedation (propofol) during surgery, and the need for analgesia (paracetamol and others) and pain assessment by visual analogue scale (VAS), post-surgery and at 24 hours. Results. Thirty patients between 5 and 16 years of age were selected consecutively, two of them being excluded because they did not meet the criteria; 15 patients were assigned to the hypnosis group and 13 to the control. Patients treated with hypnosis as an adjuvant to conscious sedation showed a lower need for propofol (median 1.8 mg/Kg; P25-75 1.6 - 2.0) than those treated with distraction (2.9; 2.5 - 3.0; p=0.001). Eighty percent of the children in the hypnosis group needed post-surgical paracetamol versus 100% in the control (p=0.226); after 24 h after discharge the difference in need of ibuprofen was 6.7% versus 38.5% (p=0.041) and of analgesics in general 46.7% versus 84.6% (p=0.082). The VAS of pain during the procedure in the hypnosis group was VAS 0 (0-0) vs 0 (0-5.5) (p=0.142). Conclusions. Hypnosis as an adjuvant to sedation in children undergoing major outpatient surgery