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Effects of hypnosis versus enhanced standard of care on postoperative opioid use after total knee arthroplasty: the HYPNO-TKA randomized clinical trial
  1. Jessie Markovits1,2,
  2. Ondrej Blaha3,4,
  3. Emma Zhao5,6 and
  4. David Spiegel2
  1. 1Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
  2. 2Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
  3. 3Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California, USA
  4. 4Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
  5. 5Stanford University School of Medicine, Stanford, California, USA
  6. 6Psychiatry, University of Vermont Medical Center, Burlington, Vermont, USA
  1. Correspondence to Dr Jessie Markovits, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; jkittle{at}stanford.edu

Abstract

Background Hypnosis decreases perioperative pain and has opioid-sparing potential but has not been rigorously studied in knee arthroplasty. This trial investigates the impact of perioperative hypnosis on inpatient opioid use following total knee arthroplasty.

Methods This prospective randomized controlled trial was conducted at a single academic medical center. The hypnosis arm underwent a scripted 10 min hypnosis session prior to surgery and had access to the recorded script. The control arm received hypnosis education only. The primary outcome was opioid use in milligram oral morphine equivalents per 24 hours during hospital admission. A secondary analysis was performed for patients taking opioids preoperatively.

Results 64 primary knee arthroplasty patients were randomized 1:1 to hypnosis (n=31) versus control (n=33) and included in the intent-to-treat analysis. The mean (SD) postoperative opioid use in oral morphine equivalents per 24 hours was 70.5 (48.4) in the hypnosis versus 90.7 (74.4) in the control arm, a difference that was not statistically significant (difference −20.1; 95% CI −51.8 to 11.4; p=0.20). In the subgroup analysis of the opioid-experienced patients, there was a 54% daily reduction in opioid use in the hypnosis group (82.4 (56.2) vs 179.1 (74.5) difference of −96.7; 95% CI -164.4 to –29.0; p=<0.01), equivalent to sparing 65 mg of oxycodone per day.

Conclusion Perioperative hypnosis significantly reduced inpatient opioid use among opioid-experienced patients only. A larger study examining these findings is warranted.

Trial registration number NCT03308071.

  • Pain Management
  • Complementary Therapies
  • Pain, Postoperative
  • Analgesics, Opioid

Data availability statement

Data are available upon reasonable request. De-identified data are available upon reasonable request at the discretion of the authors beginning two years after the publication of the manuscript, by request to corresponding author, jkittle@stanford.edu.

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Data availability statement

Data are available upon reasonable request. De-identified data are available upon reasonable request at the discretion of the authors beginning two years after the publication of the manuscript, by request to corresponding author, jkittle@stanford.edu.

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Footnotes

  • Twitter @DocMarkovits

  • Contributors JM: Study design and execution, data collection and interpretation, manuscript drafting and revisions. OB: Data analysis plan and analysis, manuscript drafting and revisions. EZ: Data collection and manuscript drafting and revisions. DS: Study design, data interpretation, manuscript drafting and revisions. JM is the guarantor of the overall content of this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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