The Effectiveness of Suggestive Techniques in Reducing Postoperative Side Effects

Zoltán Kekecs, Tamás Nagy, Katalin Varga
2014 Anesthesia and Analgesia  
This report is a meta-analysis. The author states that the report includes every item in the PRISMA checklist for meta-analysis clinical studies. This manuscript was screened for plagiarism using Dupli Checker. Link to Title Abstract Background Suggestive interventions such as hypnosis and therapeutic suggestions are frequently used to alleviate surgical side effects, however the effectiveness of therapeutic suggestion intervention have not been systematically evaluated yet. The present study
more » ... The present study tested the hypotheses that 1) suggestive interventions are useful in reducing postoperative side-effects; 2) therapeutic suggestions are comparable in effectiveness to hypnosis; 3) live presentation is more effective than recordings; and that 4) suggestive interventions would be equally effective used around minor and major surgeries. Methods We performed random effect meta-analysis with meta-regression and sensitivity analysis by moderating factors on a pool of 26 studies meeting the inclusion criteria (N = 1,890). Outcome variables were postoperative anxiety, pain intensity, pain medication requirement and nausea. Results Suggestive interventions reduced postoperative anxiety (g = 0.40; 95% CI = 0.20, 0.59; p < .001), pain intensity (g = 0.25; 95% CI = 0.06, 0.44; p = .010) and nausea (g = 0.38; 95% CI = 0.05, 0.71; p = .026); but did not significantly affect postoperative analgesic drug consumption (g = 0.16; 95% CI = -0.08, 0.40; p = .202).Moderator analysis revealed that hypnosis was significantly more effective in decreasing anxiety than therapeutic suggestions (z = 2.51; p = .012), that live presentation was more effective in alleviating postoperative pain than recordings (z = 2.18; p = .029), while recordings reduced analgesic drug requirement more effectively (z = -2.08; p = .037). Sensitivity analyses also suggested that suggestive interventions are only effective in decreasing pain intensity during minor surgical procedures (g = 0.39; 95% CI = 0.10, 0.69; p = .009). Conclusions Suggestive techniques are useful tools to alleviate postoperative side-effects although the size of the effect differ among outcomes. Contrary to our hypothesis therapeutic suggestions proved to be less effective than hypnosis interventions, and the moderating effect of presentation method (live vs. recorded) remain ambiguous. Our hypothesis that suggestive interventions alleviate postoperative anxiety both in minor and major procedures was supported, however they only seem to be effective in pain management in minor surgeries. For clinical purposes we advise the use of hypnosis with live presentation. Further research is needed to uncover additional moderating factors of effectiveness.
doi:10.1213/ane.0000000000000466 pmid:25289661 fatcat:t6tj5iqwqbaufdg3mj4rld6etq