Background: General anesthesia does not block central nervous processing of auditive information. Therefore,\npositive suggestions even given during surgery might have the potential to encourage well-being and recovery of\npatients.\nAim of this review was to summarize the evidence on the efficacy of therapeutic suggestions under general\nanesthesia in adults undergoing surgery compared to an attention control (i.e. white noise).\nMethods: We included randomized controlled trials that investigated therapeutic suggestions presented during\ngeneral anesthesia to adult patients undergoing surgery or medical procedures. Outcomes on pain intensity, mental\ndistress, recovery, use of medication, measured postoperatively within hospitalization were considered. Electronic\nsearches were carried out in the following databases (last search February 23, 2015): MEDLINE, CENTRAL, Web of\nScience, PsycINFO, ProQuest Dissertations and Theses.\nResults: Thirty-two eligible randomized controlled trials were included, comprising a total of 2102 patients. All\nstudies used taped suggestions. Random effects meta-analyses revealed no effects on pain intensity (Hedgesââ?¬â?¢ g = 0.\n04, CI 95% [âË?â??0.04; 0.12], number needed to treat [NNT] = 44.3) and mental distress (g = 0.03, CI 95% [âË?â??0.11; 0.16],\nNNT = 68.2). In contrast, we found small but significant positive effects on use of medication (g = 0.19, CI 95% [0.09;\n0.29], NNT = 9.2) and on recovery (g = 0.14, CI 95% [0.03; 0.25], NNT = 13.0). All effects were homogeneous and\nrobust.\nConclusions: Even though effects were small, our results provide indications that intraoperative suggestions can\nhave the potential to reduce the need for medication and enhance recovery. Further high quality trials are needed\nto strengthen the promising evidence on the efficacy of therapeutic suggestions under general anesthesia for\npatients undergoing surgery.
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