Awake stapedectomy under hypnoanalgesia: Efficacy and safety in the treatment of otosclerosis

Abstract

Objective: To evaluate the efficacy and safety of awake stapedectomy under hypnoanalgesia (HA) compared to general anesthesia (GA) and local anesthesia (LA) in patients with otosclerosis.

Methods: A single-center retrospective study included 131 adult patients (mean age: 49 years; 78% female) who underwent laser stapedectomy between 2020 and 2022: 58 GA, 23 LA, 50 HA. Primary outcome measures comprised operative room occupancy time, anesthetic consumption, and postoperative audiometric results.

Results: HA significantly reduced operative room occupancy time (73.5±18.6min vs 103.7±24.6min in GA, P<0.001; vs 81.8±20.5min in LA, P=0.092), stapedectomy duration (39.9±12.4min vs 48.9±21.5min in GA, P=0.0252; vs 38.9±13.2min in LA, P=0.4601), preoperative time (30.2±9.5min vs 45.7±9.5min in GA, P<0.001; vs 38.6±12.2min in LA, P=0.0022), and recovery room time (26±15.1min vs 67.5±20.7min in GA, P<0.001; vs 47.4±20.7min in LA, P<0.001). HA also significantly reduced remifentanil consumption (169.8±101.6μg vs 848.6±308.8μg in GA, P<0.001; vs 323.9±94.4μg in LA, P<0.001). Postoperative audiometric outcomes showed no significant differences between groups.

Conclusion: Hypnoanalgesia for awake stapedectomy provided significantly greater efficacy compared to general anesthesia, reducing operative time and anesthetic consumption, with comparable audiometric outcomes.

Keywords: Awake surgery; Hypnoanalgesia; Hypnosis; Local anesthesia; Otosclerosis; Stapedectomy.