Emergency medical hypnosis: a useful adjunct in the suturing of children

Background

Analgesia, anaesthesia and sedation have all been used singly and in combination for the suturing of children's minor lacerations in the emergency room. Failure of such techniques often result in a child receiving further distress and potential risk of a general anaesthetic. Alternative techniques including music, fairy tales and play therapy have been used to help district children during such procedures. Hypnosis (formal medical relaxation: FMR) has been reported anecdotally to be successful but no prospective randomised trials have been published. If hypothesis is successful the child will remain calm content and immobile without restraint throughout the procedure resulting in complete compliance and successful closure of wounds in the ER.

Aim

To assess the efficacy of FMR on children requiring suturing of wounds in the emergency room.

Population

Fifty children aged between 5–12 with wounds requiring suture.

Exclusions

any child with: head injury; depressed level of consciousness; on epileptic or other neuropharmaeological drugs; need for opiate analgesia.

Setting

An urban paediatric ER which sees more than 25,000 children per year.

Method

Children randomised into two groups: Control: Wounds sutured in the standard manner (warm 2% lignocaine, paediatric nurse and parents in attendance. Emergency medicine resident suturing). Experimental: The standard manner and formal medical relaxation. The experimental group was sutured by the chief resident (senior registrar).

Measurements

Behavioural (CHEOPS) and Visual Analogue Scales were used prior to, during and post-procedure to assess level of activity.

Results

The CHEOPS score fell during the procedure where FMR was employed in over 75% of cases. Children and parent satisfaction was recorded as higher in the FMR group. Further results to follow.

Conclusion

This pilot study in the use of hypnosis in the ER has been shown to be statistically significant. To further validate it, a double blind trial will be required.