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

Marco Scaglione; Alberto Battaglia; Andrea Lamanna; Natascia Cerrato; Paolo Di Donna; Enrico Bertagnin; Milena Muro; Carlo Alberto Caruzzo; Marco Gagliardi; Domenico Caponi

doi:10.1016/j.ijcha.2021.100839

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

Int J Cardiol Heart Vasc. 2021 Jul 13:35:100839. doi: 10.1016/j.ijcha.2021.100839. eCollection 2021 Aug.

Affiliations

¹ Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy.
² Pain Therapy and Palliative Care, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Italy.

Abstract

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), peri-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.

Keywords: Analgo-sedation; Hypnosis; Hypnotic communication; ICD, Implantable Cardioverter Defibrillator; NRS, Numeric Rating Scale; S-ICD, Subcutaneous Implantable Cardioverter Defibrillator; Subcutaneous implantable cardioverter defibrillator.