1. Nijmegen, The Netherlands
Talk and Sleep……….. Hypnotic Techniques for Sedation in Regional Anesthesia
Geert-Jan van Geffen
Radboud University,
Nijmegen, The Netherlands

7. Surgery, 2015

13. “This is not about the hypnosis you may have seen in the movies –
the one featuring the devious villain with the mesmerizing stare or dangling watch.
Our techniques also have nothing to do with lengthy sessions on a psychoanalytical couch.”
E. Lang: Patient Sedation without Medication

14. Hypnosis is a state of attentive receptive concentration that helps patients to explore their own capacity to interact with a painful or uncomfortable situation.
E. Lang: Patient Sedation Without Medication
Hypnosis - a wakeful state of focused attention and heightened suggestibility, with diminished peripheral awareness.
Jeffrey Stephens

16. Placebo – Nocebo Negative Suggestions

18. The subjects experienced an increase in pain/discomfort during most of the trials
(in 68% of all, RF and sham)

21. Contexts induce responses

22. The effect of treatment expectations

24. BMJ 2006;18:332-

33. Sympathizing after the stimulus
did not affect subsequent pain ratings (2,7 vs. 2,5)
increased significantly subsequent anxiety ratings

34. It is better not to say anything or to say something neutral,
Thus giving patients the right to their own experience.
Avoid mentioning pain or any of its euphemisms and instead focus on predicting
a possible sensation of coolness, warmth, or “a sense of delicious tingling”.
The “delicious sense of tingling” works really well, probably because of its element
of surprise and the mind starting to work on what that might be like.
E. Lang: Patient sedation without medication

36. Healthcare providers who use negative suggestions
either truly believe such suggestions are helpful to patients
and/or
are simply repeating the vocabulary and approach they have been taught and with which they have become familiar.

40. Hypnotic language

44. Comfort Talk ® is very much about awareness and subtle adaptations of language. The way you say things can make quite a difference in the outcome. Words are powerful and suggestive enough to shape a person’s subsequent experience.
E. Lang: Patient sedation without medication

46. Will this hurt ?
“Some people tell me it hurts while others are surprised it is more comfortable than they thought it would be.”

47. If a patiënt is anxious that there will be ‘too many people’in the operating room:
“Every staff member has their own job to do, in order to ensure your comfort and safety”

48. If a patient is concerned about postoperative nausea and vomiting: “We will give you medication to ensure that you can eat and drink as soon as you feel like it! “

49. Hypno-sedation

57. Comfort Talk® Method of non-pharmaceutical sedation
80% rapport and choice of words incl. hypnoidal language
20% guidance to self-hypnotic relaxation (script)
Training using the R3TM process:
Rapport, Relaxation, Reframing
Evidence-based on 20 yrs experience
Published large-scale clinical trials

61. Tumor Embolization Study
Prospective randomized trial
3 treatment conditions
Standard Care
Empathic Attention Control
Self-hypnotic Relaxation
(Empathic Attention + Relaxation Script)
Planned 300 patient
Lang et al, J Vasc Intervent Radiol 2008; 19:897 61

62. 62

63. 63

64. Adverse Events during Tumor Embolization
BP changes > 50 mm Hg (to <105 or >180 mm Hg)
Vaso-vagal episodes
Arrhythmia, chest pain, ECG changes
Oxygen saturation <90%
Medical therapy to restore stability
Lang et al, J Vasc Intervent Radiol 2008; 19:897 64

65. Adverse Events during Tumor Embolization
Standard of Care: 18/70
Empathic Attention: 31/65
Self-Hypnotic Relaxation: 8/66
E>H p=0.0001; E>S p=0.0118; H,S p= NS
Lang et al, J Vasc Intervent Radiol 2008; 19:897 65

66. Guided Imagery

67. Where do you like to go when you want to feel safe and comfortable ?

68. … you will want to always engage all of the senses and have the patients fully drawn into the experience through all senses.
E. Lang: Patiënt sedation without medication