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Abstract
Background and objectives Perioperative psychological stress and pharmacological anxiolysis can negatively affect the quality of recovery after total knee arthroplasty. We aimed to assess whether hypnosis combined with virtual reality could reduce intraoperative pharmacological sedation and improve quality of recovery after total knee arthroplasty surgery.
Methods In this prospective randomized clinical trial, 60 patients scheduled for total knee arthroplasty with spinal anesthesia were randomly divided into 2 groups of 30 patients each. Intraoperatively, intermittent boluses of midazolam 1 mg were administered at 5 min intervals at the patient’s request, with a maximum driven by the clinical assessment of sedation depth. During surgery, patients received standard care (group control) or virtual reality hypnosis (group VRH). An unblinded observer recorded the total dose of midazolam administered during surgery, and changes in the Quality-of-Recovery 15-item score, comfort, fatigue, pain and anxiety before and 1, 3 and 7 days after surgery.
Results Patients in the VRH group required a lower dose of midazolam (mg; median (range)) intraoperatively (group VRH: 0 (0–4) and group control: 2 (0–9), p<0.001). Quality-of-Recovery 15-item, anxiety, and pain were similar between groups.
Conclusions In total knee arthroplasty with spinal anesthesia, VRH reduces the requirement for intraoperative pharmacological sedation, without a change in the quality of recovery.
Trial registration number NCT05707234.
- Acute Pain
- Lower Extremity
- Pain Management
- Outcome Assessment, Health Care
- Drug-Related Side Effects and Adverse Reactions
Data availability statement
Data are available on reasonable request.
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- Acute Pain
- Lower Extremity
- Pain Management
- Outcome Assessment, Health Care
- Drug-Related Side Effects and Adverse Reactions
Data availability statement
Data are available on reasonable request.
Footnotes
VLB and AV contributed equally.
Presented at Preliminary results of this study have been presented at the Annual Congress of the French Society of Anesthesia and Intensive Care (Société Française d’Anesthésie Réanimation, SFAR), held in Paris on September 20, 2023–September 22, 2023.
Contributors MC is the author responsible for the overall content as the guarantor. This author conceived the study, wrote the protocol, helped perform data acquisition and analysis, and wrote the manuscript. FB: This author helped in data acquisition and analysis, and reviewed the manuscript. CQ: This author helped writing the protocol and conceiving the study, and reviewed the manuscript. MMA: This author helped in data acquisition and reviewed the manuscript. AL: This author helped in data acquisition and reviewed the manuscript. VLB: This author helped conceiving the study and reviewed the manuscript. AV: This author helped conceiving the study, writing the protocol, and reviewed the manuscript. VLB and AV are joint last authors.
Funding This work was supported by the University and University Hospital of Liege and its Department of Anesthesia and Intensive Care Medicine and Algology Interdisciplinary Centre, AstraZeneca foundation, the Leon Fredericq foundation, Belgium Foundation Against Cancer (Grant No: 2017064 and C/2020/1357), and the European Foundation of Biomedical Research FERB Onlus and Wallonia as part of a 474 program of the BioWin Health Cluster framework.
Competing interests MC has received interview and speaker’s honoraria from GE Healthcare, Baxter and Aguettant He is member of the Belgian Association for Regional Anesthesia Board. VLB has received funds and research support from Orion Pharma as well as honoraria from Medtronic. He has financial relationships with Grünenthal. He is Deputy Editor-in-Chief of the Acta Anaesthesiologica Belgica, and has a consultancy contract with Edwards Medical. CQ was employee at Oncomfort at the time the study was conducted. Other authors declare no conflicts of interest.
Provenance and peer review Not commissioned; externally peer reviewed.
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