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. 2025 Nov;39(11):7324-7335.
doi: 10.1007/s00464-025-12110-8. Epub 2025 Aug 27.

Implementation of the enhanced recovery after bariatric surgery (ERABS) protocol with clinical hypnosis: effects on pain and postoperative nausea and vomiting (PONV) management in bariatric surgery

Alessandra Moretti  1 , Nicolas Zucchini  2   3 , Enrico Moroni  4 , Danilo Sirigu  5 , Daniela Sanna  1 , Monica Musio  6 , Pierpaolo Terragni  7 , Giovanni Fantola  4
Affiliations

Implementation of the enhanced recovery after bariatric surgery (ERABS) protocol with clinical hypnosis: effects on pain and postoperative nausea and vomiting (PONV) management in bariatric surgery

Alessandra Moretti et al. Surg Endosc. 2025 Nov.

Erratum in

Abstract

Introduction: Obesity is a major global health issue requiring tailored anesthetic and analgesic strategies due to associated physiological and pharmacokinetic changes. The Enhanced Recovery After Bariatric Surgery (ERABS) protocol has been introduced to optimize perioperative care, but its implementation remains inconsistent. This pilot study investigates the integration of a perioperative clinical hypnosis (CH) protocol with ERABS to assess its effects on postoperative pain, nausea, and analgesic/antiemetic drug consumption in patients undergoing bariatric and metabolic surgery (BMS).

Materials and methods: A total of 42 patients undergoing elective gastric bypass were enrolled and divided into two groups: one receiving standard ERABS protocol plus CH (Group A) and the other receiving only ERABS (Group B). Pain levels, nausea, and medication use were assessed at 12 and 24 h post-surgery.

Results: Results showed a significant reduction in pain in the CH group at both 12 h (mean NRS: 2.9 vs. 5.8, p = 0.0007) and 24 h (mean NRS: 1.4 vs. 3.3, p = 0.0019). CH also led to a reduction in rescue analgesic use at 12 h (p = 0.05), though no significant differences were found at 24 h. Postoperative nausea and vomiting incidence was lower in the CH group but did not reach statistical significance.

Conclusions: These findings suggest that perioperative CH could be a valuable adjunct to ERABS, improving postoperative pain management and reducing analgesic consumption in the first 12 h post-surgery. Given the study's limitations, including small sample size and single-center design, further multicenter trials are recommended to confirm these preliminary results and explore the underlying mechanisms of CH in surgical recovery.

Keywords: Bariatric surgery; Clinical hypnosis; ERABS.

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Conflict of interest statement

Declarations. Disclosures: Drs. Moretti Alessandra, Zucchini Nicolas, Moroni Enrico, Sirigu Danilo, Sanna Daniela, Musio Monica, Terragni Pierpaolo, and Fantola Giovanni have no conflicts of interest or financial ties to disclose. Ethical approval: The corporate ethics committee approved the application of periprocedural clinical hypnosis within the ARNAS G. Brotzu hospital. All participants in the study provided their informed consent in compliance with Italian regulations on personal data protection (EU Regulation 2016/679-GDPR) before being included in the research.

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