Adjunctive hypnotic communication for analgosedation in subcutaneous implantable cardioverter defibrillator implantation. A prospective single center pilot study.

BACKGROUND

Subcutaneous implantable cardioverter defibrillator (S-ICD) is a well-established therapy for sudden death prevention. Considering the painful nature of the procedure anaesthesia may be required for analgo-sedation. Hypnosis is emerging as a promising therapeutic strategy for pain control. Few data are available regarding the use of hypnosis as adjunctive technique for pain control during S-ICD implantation.

METHODS

Thirty consecutive patients referred to our centre for S-ICD implantation were prospectively and alternatively allocated with 1:1 ratio in two groups: A) Standard analgo-sedation approach (Hypnosis non responder patients) B) Standard analgo-sedation approach with the addition of hypnotic communication (Hypnosis responder patients). Peri-procedural pain perception and anxiety, perceived procedural length, type and dosage of administered analgesic drugs have been measured using validate scores and compared.

RESULTS

Hypnotic communication was offered to 15 patients of which was successful in 11 patients (73%). There were no statistical differences between the two study groups according to baseline characteristics. Hypnosis communication resulted in significant pain perception reduction (Group A 6,9 ± 1,6 Vs Group B 1,1 ± 0,9, p value < 0,01), -procedural anxiety (Group A 3,5 ± 1,6 Vs Group B 1,9 ± 0,5, p value < 0,01) and reduced perceived procedural length (Group A 58,7 ± 13,4 min Vs Group B 44,7 ± 5,5 min, p value < 0,01). Fentanyl dosage was significantly lower in Group B patients.

CONCLUSIONS

Our results demonstrated a significant reduction of perceived pain, anxiety, procedural time and use of analgesic drugs in hypnosis responder patients. These results reinforce the beneficial effects of the hypnotic technique in patients undergoing S-ICD implantation.