The impact of hand reflexology on pain, anxiety and satisfaction during minimally invasive surgery under local anaesthetic: a randomised controlled trial

Int J Nurs Stud. 2015 Dec;52(12):1789-97. doi: 10.1016/j.ijnurstu.2015.07.009. Epub 2015 Jul 26.


Background: Elevated patient anxiety during surgery is linked to a range of suboptimal treatment outcomes. Reflexology has been reported to be effective in reducing pre and post-operative anxiety and post-operative pain.

Objectives: To explore whether the addition of hand reflexology to treatment as usual during minimally invasive varicose vein surgery under local anaesthetic impacted upon patient reported anxiety and pain during surgery, and patient satisfaction with treatment.

Design: Randomised controlled trial.

Setting: Private outpatient clinic specialising in venous conditions.

Participants: 137 participants were assessed for eligibility. One hundred patients were recruited (mean age 47.8 years, 83% female). Participants received endovenous thermal ablation and/or phlebectomy for the treatment of varicose veins. Inclusion criteria included age (between 18 and 80) and receiving endovenous thermal ablation and/or phlebectomy for the treatment of varicose veins under local anaesthetic. Exclusion criteria included the presence of leg ulcers and receiving microsclerotherapy or foam sclerotherapy treatments, being unwilling to enter into the randomisation process and arriving late at the clinic.

Methods: Participants were randomly allocated to either treatment as usual (control group) or intra-operative hand reflexology during minimally invasive varicose vein surgery under local anaesthetic. Participants in the reflexology group received a session of intra-operative hand reflexology which began in the operating theatre, prior to analgesic injections and continued until surgery was complete. It was not possible to blind the participants, researchers or theatre staff to group allocation due to the modifications required to the operating theatre for participants in the reflexology group. The researcher could not be blinded due to the role they played in the trial organisation.

Results: Of the 137 participants screened for eligibility, 7 participants declined to participate and a further 30 did not meet the inclusion criteria, giving a recruitment rate of 93%. Fifty participants were randomised to the reflexology group and fifty participants were randomised to the control group. Intra-operative anxiety was significantly lower in the reflexology group (mean score of 3.24 on an 11-point rating scale) than the control group (mean score of 5.0, p<.001).

Conclusions: Intra-operative hand reflexology is a useful adjunct to local anaesthetic varicose vein surgery, with participants in the reflexology group reporting significantly lower intra-operative anxiety and shorter pain duration than participants receiving treatment as usual.

Keywords: Anxiety; Endovenous surgery; Minimally invasive surgery; Pain; Randomised controlled trial; Reflexology; Satisfaction; Varicose veins.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia, Local*
  • Anxiety / therapy*
  • Female
  • Hand / surgery*
  • Humans
  • Male
  • Massage* / methods
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods*
  • Pain, Postoperative / therapy*
  • Patient Satisfaction
  • Varicose Veins / surgery
  • Young Adult