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Effect of virtual reality hypnosis on intraoperative sedation needs and functional recovery in knee arthroplasty: a prospective randomized clinical trial
  1. Michele Carella1,2,
  2. Florian Beck1,3,
  3. Caroline Quoilin4,
  4. Murielle M Azongmo1,
  5. Adrien Loheac1,
  6. Vincent L Bonhomme1,3 and
  7. Audrey Vanhaudenhuyse5,6
  1. 1Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Universitaire de Liège, Liège, Belgium
  2. 2Inflammation and Enhanced Rehabilitation Laboratory (Regional Anesthesia and Analgesia), GIGA-I3 Thematic Unit, GIGA-Research, Liège University, Liège, Belgium
  3. 3Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, GIGA Research, Liège University, Liège, Belgium
  4. 4Oncomfort SA, Wavre, Belgium
  5. 5Interdisciplinary Algology Center, Centre Hospitalier Universitaire de Liège, Liège, Belgium
  6. 6Sensation and Perception Research Group, GIGA-Consciousness, GIGA Research, Liège University, Liège, Belgium
  1. Correspondence to Dr Michele Carella, Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Universitaire de Liège, Liège 4000, Belgium; mcarella{at}chuliege.be

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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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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.