Evidence map›Paper›PMID 33303476›Full record

Trial reportBMJ (Clinical research ed.)2020

Effect of therapeutic suggestions during general anaesthesia on postoperative pain and opioid use: multicentre randomised controlled trial.

Hartmuth Nowak, Nina Zech, Sven Asmussen, Tim Rahmel, Michael Tryba, Guenther Oprea, Lisa Grause, Karin Schork, Manuela Moeller, Johannes Loeser and 7 more

Open access · hybridAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
40citing papers in PubMed, 1 pooled it
10.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

40 citing papers in PubMed, 1 synthesis or guideline pooled it, 98 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 6 institutions in 1 country.

Hartmuth NowakDepartment of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany.
Nina ZechDepartment of Anesthesiology, University Hospital Regensburg, University of Regensburg, Regensburg, Germany.
Sven AsmussenDepartment of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany.
Tim RahmelDepartment of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany.
Michael TrybaClinic for Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Kassel Hospital, Kassel, Germany.
Guenther OpreaDepartment of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany.
Lisa GrauseDepartment of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany.
Karin SchorkMedizinisches Proteom-Center, Ruhr University Bochum, Bochum, Germany.
Manuela MoellerKassel School of Medicine, Kassel, Germany.
Johannes LoeserDepartment of Anesthesiology and Intensive Care Medicine, University Hospital, University of Cologne, Cologne, Germany.
Katharina GyarmatiDepartment of Anesthesiology and Intensive Care Medicine, University Hospital, University of Cologne, Cologne, Germany.
Corinna MittlerDepartment of Anesthesiology and Intensive Care Medicine, University Hospital, University of Cologne, Cologne, Germany.
Thomas SallerDepartment of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany.
Alexandra ZaglerDepartment of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany.
Katrin LutzDepartment of Anesthesiology, University Hospital Regensburg, University of Regensburg, Regensburg, Germany.
Michael AdamzikDepartment of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany.
Ernil HansenDepartment of Anaesthesiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany ernil.hansen@ukr.de.ORCID 0000-0002-0931-3789
Universitätsklinikum Knappschaftskrankenhaus Bochum · DEUniversity Hospital Regensburg · DEUniversity of Cologne · DELMU Klinikum · DEUniversity of Kassel · DERuhr University Bochum · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo investigate the effect of therapeutic suggestions played to patients through earphones during surgery on postoperative pain and opioid use.

designBlinded randomised controlled study.

settingFive tertiary care hospitals in Germany.

participants385 of 400 patients consecutively recruited from January to December 2018 who were to undergo surgery for 1-3 hours under general anaesthesia. In the per protocol analysis 191 patients were included in the intervention group and 194 patients in the control group.

interventionThe intervention comprised an audiotape of background music and positive suggestions based on hypnotherapeutic principles, which was played repeatedly for 20 minutes followed by 10 minutes of silence to patients through earphones during general anaesthesia. Patients in the control group were assigned to a blank tape.

main outcome measuresThe main outcome was dose of opioid administered by patient controlled analgesia or nurse controlled analgesia within the first postoperative 24 hours, based on regular evaluation of pain intensity on a numerical rating scale (range 0-10, with higher scores representing more severe pain).

resultsCompared with the control group, the intervention group required a significantly (P=0.002) lower opioid dose within 24 hours after surgery, with a median of 4.0 mg (interquartile range 0-8) morphine equivalents versus 5.3 (2-12), and an effect size (Cohen's d) of 0.36 (95% confidence interval 0.16 to 0.56). The number of patients who needed opioids postoperatively was significantly (P=0.001) reduced in the intervention group: 121 of 191 (63%, 95% confidence interval 45% to 70%) patients in the intervention group versus 155 of 194 (80%, 74% to 85%) in the control group. The number needed to treat to avoid postoperative opioids was 6. Pain scores were consistently and significantly lower in the intervention group within 24 hours after surgery, with an average reduction of 25%. No adverse events were reported.

conclusionsTherapeutic suggestions played through earphones during general anaesthesia could provide a safe, feasible, inexpensive, and non-drug technique to reduce postoperative pain and opioid use, with the potential for more general use. Based on the finding of intraoperative perception by a considerable number of patients, surgeons and anaesthetists should be careful about background noise and conversations during surgery.

trial registrationGerman Clinical Trial Register DRKS00013800.

Indexed as

Anesthesia, GeneralSuggestionAdolescentAdultAgedAnalgesia, Patient-ControlledAnalgesics, OpioidFemaleGermanyHumansIntraoperative PeriodMaleMiddle AgedMusic TherapyPain ManagementPain MeasurementAnalgesics, Opioid

Identifiers

PMID33303476
PMCPMC7726311
OpenAlexW3111670027

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.