Peri-operative Stress Response – The Missing Link in my Personal Journey As I lie in my bed, post op, an overwhelming sense of excitement rushes through me. Not the sort of sensation you would normally experience with post-operative recovery. It’s a real buzz, a sense of discovery and recognition of my own physiological response, mapped against my knowledge of trauma and stress, and work that I regularly encounter as a craniosacral therapist. Two contrasting peri-operative experiences and two distinct physiological stories have enabled me to view my experience in a much wider field. One of the key aspects of this reflection has been revisiting my very palpable fear of needles and how that impacts my nervous system and physiology. I have often feared being deemed, and have in fact been unsympathetically dismissed, as being “silly” or “ridiculous”. As early as my student years, I remember vain attempts to “overcome” this fear by donating blood, only to be politely turned away – the half pint I was able to donate never really matched the nursing time taken to care for me in my recovery. It is only recently, as my second surgery loomed that I was able to meet this phobia from an alternative angle, to view it more as a form of embodied intelligence, my body’s natural protective instinct to an unnatural invasion. Meeting aspects of the Self unconditionally shifts our physiology but equally important was to recognise this fear’s effect on my nervous system. This perspective shifted profoundly following my recent surgeries and enabled me to see my experiences with new awareness. Last October, I underwent repair surgery for a femoral hernia. Sadly, the surgery was unsuccessful, and I returned for further surgery to repair the recurrent hernia. It was these two experiences that I discovered a much wider context to surgical trauma that included a deeper layer of understanding about the pre-operative stress response and its real, tangible impact – not only on surgical outcomes, but on recovery and emotional well-being. The Physiology Behind the Stress Response We know that surgery activates both the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis. This leads to a flood of catecholamines and cortisol. This is a lifesaving response, designed to help us survive in moments of danger but detrimental when prolonged or not fully processed. The acute stress response includes tachycardia, hypertension, hyperglycaemia and immunosuppression and can be maladaptive in a surgical context, contributing to post-operative complications, delayed healing and chronic pain. There is sufficient research in this field, but much of the focus is weighted heavily towards pharmacology, controlling and managing anaesthesia, depth, pain and haemodynamics. It rarely integrates the psychological, environment and relational factors that contribute to a patient’s stress response, most of which are predominant at the pre-operative phase. The term peri-operative refers to the entire surgical journey — before (pre-operative), during (intra-operative), and after surgery (post-operative). While medical care often focuses on the surgical act itself, the nervous system is responding across all these phases. Understanding and supporting the whole peri-operative period allows for a more holistic and trauma-informed approach to healing. The Chaotic First Surgery: Fight, Flight, Freeze Although this was not my first encounter with general anaesthetic, it was my first significant surgery in adulthood and I could feel this apprehension in my body as I shuttled to and fro from resource. Despite knowledge, there is only so much you can rationalise when the body’s innate survival system is triggered. The hospital environment that day felt like a storm brewing; the nerves of a secretary’s first day at work, the long line of patients carrying their own fears and apprehensions, the anaesthetist, on a time-saving mission, coming onto the ward to cannulise me without acknowledging my fear of needles. My surgeon, due to staff shortages, leaving theatre to collect me himself, his own anxiety about completing his surgeries for the day adding to the mounting tension. My sense of safety collided with the tension and urgency in this environment and the day’s mounting pressures began to take their toll on my well-being. I named the fast pace to the medical team, in a desperate hope to slow things down. Unacknowledged, I was driven further into a feeling of unsafety. I was powerless and my last words, “my legs are going”, were met with silence, as the surgical masked was placed over my face and the anaesthetic was administered. My legs had wanted to run, but I wasn’t going anywhere, I was stuck, and I went into controlled consciousness in a state of Flight. I had expected signs of trauma from the surgery itself and had scheduled craniosacral treatment for myself, alongside the work I was already doing on my own physiology. But despite my efforts, my body felt confused, disjointed and disconnected. I was surprised at how challenging it was to resource myself, many of my usual strategies felt inadequate in restoring any sense of “feeling OK”. My first days post-surgery were marked by an irresistible urge to flick my legs out as they trembled and shook. This constant need to stretch my lower limbs persisted for several weeks, gradually easing with craniosacral therapy. This sense of physiological chaos lingered much longer than I had anticipated. An unfamiliar anxiety began to creep in, one that felt disproportionate to the surgical outcome itself. I was feeling despondent, and my body carried a heavy, weighted fog. It took persistent resourcing, self-care and the invaluable support of family and friends to slowly crawl out the other side. A New Experience: Feeling Safe, Healing Differently Of course, second time round, my mind and body weren’t carrying the same anticipations, and my second surgery was different in methodology. These factors alone, influenced how I felt that day and inevitably impacted my surgery and healing outcomes. However, it was my interactions with my anaesthetist that had a lasting impact on me. They took time, they sat with me on the ward, made eye-contact, paused, acknowledged my fear of needles non-judgementally and compassionately, provided solutions to make the experience as comfortable as possible. They continued to hold a safe, respectful and empowering space as they administered the anaesthetic. Their skill set extended far beyond the life-saving administration of drugs. I was held holistically as I gently slipped into my controlled unconsciousness. The result? My immediate post-operative recovery was smoother, lighter, quicker. I experienced significantly less physical agitation, and a more regulated emotional state in the days that followed. Longer term, too, my healing trajectory felt more integrated. Scar tissue softened faster, my sleep returned more quickly, and the return to full energy came without the emotional heaviness that had shadowed the first experience. I still experienced trembling in the fascia located in the abdominal cavity, site of surgical intervention, but this felt localised and manageable. There was no charge or jarring from my legs and my whole body felt integrated and calm. I hadn’t connected the link between my felt sense to the anaesthesia or the pre-operative experience. Only now are the pieces falling into place. The excitement I feel is the recognition of this missing link. Moving Beyond Anaesthesia: Holistic Opportunities It’s the simple things- being met with presence, recognising individual needs, fostering trust – that have the most profound impact on our nervous system. When psychological, environmental and relational factors are integrated into care, something shifts, our nervous system calms. Hypnotic language, mindful handling and even the time to acknowledge a patient’s fears can influence the trajectory of not only the surgery but the healing that follows. A trial exploring the use of acupuncture to reduce perioperative anxiety (Ref:A randomised trial examining the effect of acupuncture at the EX-HN3 (Yintang) point on pre-operative anxiety levels in neurosurgical patients, PubMed), showed measurable improvements in levels of anxiety and post operative outcomes. If we were to apply a similar lens to craniosacral therapy, it raises important questions. What is the motility in the fascia like in surgery if the central nervous system is less activated? If the motility of tissue is supported, how does this impact surgical outcome and recovery? Non-pharmacological interventions such as music therapy, cognitive behavioural therapy and Craniosacral Therapy (CST) are certainly gaining traction in their ability to mitigate stress without unwanted side effects but widespread integration of complementary practice into mainstream medical practice feels a long way off. As a craniosacral therapist, we know how much of a difference CST therapy could make here but our world is lacking in the research and evidence that the world of science and medicine demand. Moving forward Reflecting on my two surgeries, it’s clear that the body’s stress response to surgery isn’t just related to a patient’s ability to heal from the actual surgery itself. There’s immense potential to transform surgical care if viewed holistically, taking pre-operative circumstances into consideration. Until now, my focus in clinic has largely been on post-operative support. But surgery, I’ve come to realise, doesn’t begin on the table. It begins in the nervous system during the pre-operative phase - long before the scalpel touches the skin – and continues through the peri-operative journey. When craniosacral therapists work with birth processes, we don’t just look at the birth itself. Our enquiry is much broader: we explore how the pregnancy unfolded, how conception was experienced, and sometimes extend our awareness into ancestral fields. In doing so, we open a wider context that helps to inform and deepen the treatment that unfolds on the table. Similarly, in my clinic, I will now actively check in and include in a client’s medical history, how they felt in the lead up to surgery and their state of mind and body immediately before entering the theatre. I will also clearly offer pre-operative support alongside post-operative treatment. I will be drawing on this personal journey, and this missing link it has revealed, to support the client’s surgical processes in a much wider, more integrated way. By tending to the nervous system at these key points, we may lessen the overall trauma to the body, ease the peri-operative stress response and enhance the body’s innate capacity to heal. Biography Vicki Sampieri is a Biodynamic Craniosacral Therapist and artist based in East Sussex, with a professional background in education. She is committed to continually reflecting on and integrating her personal experiences to enhance her effectiveness as a craniosacral therapist. Her recent surgical journey has deepened her understanding of the perioperative stress response and strengthened her holistic approach to supporting clients through both pre- and post-operative care. She also has a keen interest in how Craniosacral Therapy can support post-concussion recovery and is currently exploring collaborations with sports researchers and scientists investigating the consequences of concussion, sub-concussion and their links to dementia. www.optimumhealththerapies.co.uk optimumhealthvs@gmail.com