Rosendahl Jenny, Koranyi Susan, Jacob Davina, Zech Nina, Hansen Ernil
Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Stoystr. 3, 07743, Jena, Germany.
Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.
BMC Anesthesiol. 2016 Dec 22;16(1):125. doi: 10.1186/s12871-016-0292-0.
General anesthesia does not block central nervous processing of auditive information. Therefore, positive suggestions even given during surgery might have the potential to encourage well-being and recovery of patients. Aim of this review was to summarize the evidence on the efficacy of therapeutic suggestions under general anesthesia in adults undergoing surgery compared to an attention control (i.e. white noise).
We included randomized controlled trials that investigated therapeutic suggestions presented during general anesthesia to adult patients undergoing surgery or medical procedures. Outcomes on pain intensity, mental distress, recovery, use of medication, measured postoperatively within hospitalization were considered. Electronic searches were carried out in the following databases (last search February 23, 2015): MEDLINE, CENTRAL, Web of Science, PsycINFO, ProQuest Dissertations and Theses.
Thirty-two eligible randomized controlled trials were included, comprising a total of 2102 patients. All studies used taped suggestions. Random effects meta-analyses revealed no effects on pain intensity (Hedges' g = 0.04, CI 95% [-0.04; 0.12], number needed to treat [NNT] = 44.3) and mental distress (g = 0.03, CI 95% [-0.11; 0.16], NNT = 68.2). In contrast, we found small but significant positive effects on use of medication (g = 0.19, CI 95% [0.09; 0.29], NNT = 9.2) and on recovery (g = 0.14, CI 95% [0.03; 0.25], NNT = 13.0). All effects were homogeneous and robust.
Even though effects were small, our results provide indications that intraoperative suggestions can have the potential to reduce the need for medication and enhance recovery. Further high quality trials are needed to strengthen the promising evidence on the efficacy of therapeutic suggestions under general anesthesia for patients undergoing surgery.
全身麻醉不会阻断听觉信息的中枢神经处理。因此，即使在手术过程中给出的积极建议也可能有潜力促进患者的身心健康和康复。本综述的目的是总结与注意力控制（即白噪音）相比，全身麻醉下治疗性建议对接受手术的成年患者疗效的证据。
我们纳入了调查全身麻醉期间向接受手术或医疗程序的成年患者提供治疗性建议的随机对照试验。考虑了住院期间术后测量的疼痛强度、精神痛苦、恢复情况、药物使用等结果。在以下数据库中进行了电子检索（最后一次检索时间为2015年2月23日）：医学文献数据库、循证医学图书馆、科学引文索引、心理学文摘数据库、ProQuest学位论文数据库。
纳入了32项符合条件的随机对照试验，共2102例患者。所有研究均使用录音建议。随机效应荟萃分析显示对疼痛强度（Hedges'g = 0.04，95%置信区间[-0.04；0.12]，需治疗人数[NNT]=44.3）和精神痛苦（g = 0.03，95%置信区间[-0.11；0.16]，NNT = 68.2）无影响。相比之下，我们发现对药物使用（g = 0.19，95%置信区间[0.09；0.29]，NNT = 9.2）和恢复情况（g = 0.14，95%置信区间[0.03；0.25]，NNT = 13.0）有小但显著的积极影响。所有效应均具有同质性和稳健性。
尽管效应较小，但我们的结果表明术中建议有可能减少药物需求并促进恢复。需要进一步的高质量试验来加强全身麻醉下治疗性建议对手术患者疗效的有前景的证据。
