Preoperative Hypnosis versus Mindfulness for Reducing Postoperative Symptoms in Breast Surgery: A Randomized Clinical Trial

Abstract

Background: Breast cancer surgery is often associated with unpleasant postoperative symptoms, including pain, nausea, fatigue, and emotional distress, which can reduce quality of life and prolong recovery times. This study aimed to test the efficacy of preoperative hypnosis in reducing postoperative symptoms after breast cancer surgery.

Methods: A total of 203 women scheduled for breast cancer surgery at Oslo University Hospital in Oslo, Norway, participated in a randomized controlled trial. Patients were randomized to receive a single session of either preoperative hypnosis or mindfulness within 2 h before their scheduled surgery. Primary outcomes were postoperative pain, fatigue, nausea, discomfort, and emotional distress, measured using 100-mm visual analog scales on the day of surgery after recovery from general anesthesia. Additional measures included amount of intraoperative and postoperative anesthesia and analgesia, as well as surgery duration (extracted from patients' medical records).

Results: Patients receiving preoperative hypnosis reported significantly lower postoperative fatigue (mean difference [MD], 6.4; 95% CI, 0.40 to 12.4; Cohen's d = 0.30) and emotional distress (MD, 5.7; 95% CI, 0.24 to 11.2; d = 0.24) when compared to patients in a mindfulness control group. There was also a significant reduction in postoperative fentanyl use among those patients receiving preoperative hypnosis (MD, -0.03; 95% CI, -0.047 to -0.005; d = 0.54). Preoperative anxiety moderated the effect of hypnosis on postoperative emotional distress, showing a more pronounced benefit for patients with high levels of preoperative anxiety. However, no significant differences were found in postoperative pain, nausea, or discomfort between the hypnosis and mindfulness groups. No adverse events attributed to the interventions were reported.

Conclusions: A brief preoperative hypnosis session before breast cancer surgery appears to be more effective than mindfulness in reducing postoperative fatigue, emotional distress, and fentanyl dose. Hypnosis stands out as a promising, nonpharmacologic, and safe intervention for reducing certain postoperative symptoms.

Trial registration: ClinicalTrials.gov NCT04518085.