5 strategies – Day of the surgery

by Verónica Ruiz


It is relatively frequent that if you are going to undergo an invasive medical procedure, as a dermatological surgery, you might experience a certain level of anxiety and fear.   

These emotions are quite understandable and are related to the fear of suffering any kind of pain, the fear of pain before and after the surgery, the uncertainty of the possible complications and consequences of the intervention and the fear to face the unknown situation that is out of control and also separated from your relatives.

Various recent studies have observed that the preoperative anxiety reduces the pain threshold being an important predictor of the pain that the patient experiences during and after the intervention, that is, the greater anxiety the patient feels, the greater the probability that they will feel more pain with the application of anesthesia, then this anesthesia is less durable and you have more pain after surgery.

It is, in this context, where the responsible doctor plays the fundamental role, being able to put at your disposal tools that promote your relaxation, that help to reduce your level of  perception of pain and that, in general, contribute to making the situation more comfortable.

Although there are various drugs that can be prescribed to reduce the stress level associated with the surgery, non-pharmacological techniques have been investigated that may also be beneficial for this purpose without the adverse effects associated with drugs.

Next, I will describe the techniques aimed at helping you manage the level of anxiety before a surgical intervention and therefore improve your perception of the experience.

1. Patient-centered communication

The results of several studies have shown that the most important factor related to a positive perception of the experience by the patient was the ability of the surgeon to establish good communication with the patient.

The construction of a good relationship between patient and doctor based on the confidence starts taking place in the preoperative visit and, even though there are no standardized or protocolized guidelines regarding the information to be provided to the patient in this visit, this would have to be individualized and based on the health problems of each patient, so that we can anticipate the possible problems/complications that could arise during or after surgery.

The fact of explaining the dynamics of the intervention, what you can expect or feel during the surgery, giving you clear guidelines on cures and postoperative pain and above all showing empathy, is the key to establishing a good doctor-patient relationship and that will undoubtedly contribute to improving their level of satisfaction.

2. Distraction mesures

  • Verbal distraction: The use of verbal distraction during the surgery, through conversation and the use of comforting words towards the patient has been considered, in some descriptive studies, as beneficial in reducing the levels of anxiety and pain on the part of the patient.
  • Distraction with musicSome studies that have investigated the effects of music on preoperative anxiety have showed heterogeneous results. Although ¨music therapy¨ is a modality that is not expensive to implement and has potential benefits, we still have little evidence to support its anxiolytic effect during surgery.

Some studies indicate that music directs the patient’s attention towards a pleasant emotional state, promotes relaxation through decreased adrenergic activity and effects the limbic system by stimulating the release of endorphins. However, the information that some studies have given, show that the therapeutic effects of music therapy would be more likely to occur if patients were allowed to select their own musical preferences.

3. Patient Education

According to the results of various studies, the use of explanatory videos on different surgical techniques and postoperative cures has been useful in increasing the efficiency of communication, improving understanding and the perception of satisfaction on the part of the patient.

4. Relaxation Techniques

The meditation, mindfulness and the hypnosis have been used in dermatological surgery to calm and rebalance the autonomic nervous system, reducing the levels of anxiety in patients.

In this way, I would like to highlight an interesting initiative promoted by professionals in the Hospital de la Paz in Madrid, who have developed the app “Calm in the operating room”, whose objective is to help the patient minimize the stress or anxiety the can experiment before a surgery. This digital tool focuses primarily on the performance of mindfulness exercises to be able to manage anxiety.

5. Mechanoanesthesia and the application of local cold

Different techniques of mechanical stimulation have been proposed at the surgical site to reduce pain related to the injection of anesthesia. For example, the pinching, scratching or massaging of the skin where the injection is put has been shown to reduce the discomfort associated with the insertion of the needle.

The application of ice or cryoanesthesia with ethyl chloride spray immediately before the puncture and introduction of the local anesthesia have been shown to slightly reduce the pain related to the puncture and injection of the local anesthetic.


It’s been shown that the efforts directed to improve your comfort during the surgery, minimizing the pain and anxiety, improve the clinical outcomes, reduce pain thresholds, reduces the requirement for pain killers and the risk of complications, they strengthen the doctor-patient relationship and increase their level of satisfaction.

Some techniques like distraction, patient-centered communication, different educational strategies, the implementation of different methods to reduce pain with the injection and some relaxation techniques such as meditation and mindfulness help to improve your experience in dermatological surgery.

These interventions are often cost-effective and easy to introduce, they avoid side effects of medications and serve as a complimentary approach to improve your comfort during the surgery.



  • Felicia Vaughn, Harriet Wichowski, Gerry Bosworth. Does preoperative anxiety level predict postoperative pain? AORN J 2007 Mar;85(3):589-604.
  • Joke Bradt, Cheryl Dileo, Minjung Shim. Music interventions for preoperative anxiety. Cochrane Database Syst Rev 2013 Jun 6;(6):CD006908.
  • Akerke Baibergenova, Christian A Murray. Techniques to minimize the pain of injected local anesthetic. J Cutan Med Surg Sep-Oct 2011;15(5):250-3.
  • Philip D Shenefelt. Relaxation strategies for patients during dermatologic surgery. J Drugs Dermatol. 2010 Jul;9(7):795-9.