Effect of virtual reality hypnosis on intraoperative sedation needs and functional recovery in knee arthroplasty: a prospective randomized clinical trial.
Acute Pain; Drug-Related Side Effects and Adverse Reactions; Lower Extremity; Outcome Assessment, Health Care; Pain Management; Anesthesiology and Pain Medicine; General Medicine
Abstract :
[en] [en] 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.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Carella, Michele ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'anesthésie - réanimation
Beck, Florian ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'anesthésie - réanimation
Quoilin, Caroline; Oncomfort SA, Wavre, Belgium
Azongmo, Murielle M; Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Universitaire de Liège, Liège, Belgium
Lohéac, Adrien ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'anesthésie - réanimation
Bonhomme, Vincent ✱; Université de Liège - ULiège > GIGA > GIGA Consciousness - Anesthesia and Intensive Care Laboratory
✱ These authors have contributed equally to this work.
Language :
English
Title :
Effect of virtual reality hypnosis on intraoperative sedation needs and functional recovery in knee arthroplasty: a prospective randomized clinical trial.
AstraZeneca [BE] Belgian Foundation Against Cancer [BE] ULiège - University of Liège [BE] Fonds Léon Fredericq [BE] CHU Liège - Central University Hospital of Liege [BE]
Funding text :
University and University Hospital of Liege and its Department of Anesthesia and Intensive Care Medicine and Algology Interdisciplinary Centre; European Foundation of Biomedical Research
Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA 2021; 325: 568-78. doi:10.1001/jama.2020.22171
Abdel MP, Berry DJ. Current practice trends in primary hip and knee arthroplasties among members of the American association of hip and knee surgeons: a long-term update. J Arthroplasty 2019; 34: S24-7. doi:10.1016/j.arth.2019.02.006
Memtsoudis SG, Cozowicz C, Bekeris J, et al. Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International consensus on anaesthesia-related outcomes after surgery group (ICAROS) based on a systematic review and meta-analysis. Br J Anaesth 2019; 123: 269-87. doi:10.1016/j.bja.2019.05.042
Stamenkovic DM, Rancic NK, Latas MB, et al. Preoperative anxiety and implications on postoperative recovery: what can we do to change our history. Minerva Anestesiol 2018; 84: 1307-17. doi:10.23736/S0375-9393.18.12520-X
Zemła AJ, Nowicka-Sauer K, Jarmoszewicz K, et al. Measures of preoperative anxiety. Anaesthesiol Intensive Ther 2019; 51: 64-9. doi:10.5603/AIT.2019.0013
Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg 1999; 89: 1346-51. doi:10.1097/00000539-199912000-00003
Conway A, Rolley J, Sutherland JR. Midazolam for sedation before procedures. Cochrane Database Syst Rev 2016; 2016: CD009491. doi:10.1002/14651858.CD009491.pub2
Gillespie GN, Porteous AJ. Obesity and knee arthroplasty. Knee 2007; 14: 81-6. doi:10.1016/j.knee.2006.11.004
Hole J, Hirsch M, Ball E, et al. Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis. Lancet 2015; 386: 1659-71. doi:10.1016/S0140-6736(15)60169-6
Faymonville ME, Fissette J, Mambourg PH, et al. Hypnosis as adjunct therapy in conscious sedation for plastic surgery. Reg Anesth 1995; 20: 145-51.
Elkins GR, Barabasz AF, Council JR, et al. Advancing research and practice: the revised APA division 30 definition of hypnosis. Am J Clin Hypn 2015; 57: 378-85. doi:10.1080/00029157.2015.1011465
Spiegel D. Neurophysiological correlates of hypnosis and dissociation. J Neuropsychiatry Clin Neurosci 1991; 3: 440-5. doi:10.1176/jnp.3.4.440
Weitzenhoffer AM. Scales, scales and more scales. Am J Clin Hypn 2002; 44: 209-19. doi:10.1080/00029157.2002.10403481
Vanhaudenhuyse A, Nyssen A-S, Faymonville M-E, et al. Recent insight on how the neuroscientific approach helps clinicians. OBM ICM 2020; 5: 1-20. doi:10.21926/obm.icm.2002028
Faymonville ME, Meurisse M, Fissette J. Hypnosedation: a valuable alternative to traditional anaesthetic techniques. Acta Chir Belg 1999; 99: 141-6.
Hoffman HG, Seibel EJ, Richards TL, et al. Virtual reality helmet display quality influences the magnitude of virtual reality analgesia. J Pain 2006; 7: 843-50. doi:10.1016/j.jpain.2006.04.006
Ahmadpour N, Randall H, Choksi H, et al. Virtual reality interventions for acute and chronic pain management. Int J Biochem Cell Biol 2019; 114: 105568. doi:10.1016/j.biocel.2019.105568
Schnur JB, Kafer I, Marcus C, et al. Hypnosis to manage distress related to medical procedures: a meta-analysis. Contemp Hypn 2008; 25: 114-28. doi:10.1002/ch.364
Rousseaux F, Bicego A, Ledoux D, et al. Hypnosis associated with 3D immersive virtual reality technology in the management of pain: a review of the literature. J Pain Res 2020; 13: 1129-38. doi:10.2147/JPR.S231737
Sessler CN, Gosnell MS, Grap MJ, et al. The richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002; 166: 1338-44. doi:10.1164/rccm.2107138
Lavand'homme PM, Kehlet H, Rawal N, et al. PROSPECT working group of the European society of regional anaesthesia and pain therapy (ESRA). pain management after total knee arthroplasty: procedure specific postoperative pain management recommendations. Eur J Anaesthesiol 2022; 39: 743-57. doi:10.1097/EJA.0000000000001691
Demumieux F, Ludes P-O, Diemunsch P, et al. Validation of the translated quality of recovery-15 questionnaire in a French-speaking population. Br J Anaesth 2020; 124: 761-7. doi:10.1016/j.bja.2020.03.011
Marteau TM, Bekker H. The development of a six-item short-form of the state scale of the spielberger state-trait anxiety inventory (STAI). Br J Clin Psychol 1992; 31: 301-6. doi:10.1111/j.2044-8260.1992.tb00997.x
Vanhaudenhuyse A, Ledoux D, Gosseries O, et al. "Can subjective ratings of absorption, dissociation, and time perception during "neutral hypnosis"predict hypnotizability?: an exploratory study". Int J Clin Exp Hypn 2019; 67: 28-38. doi:10.1080/00207144.2019.1553765
Chung F, Abdullah HR, Liao P. STOP-bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest 2016; 149: 631-8. doi:10.1378/chest.15-0903
Spielberger CD. State-trait anxiety inventory for adults.. In: Weiner IB, Craighead WE, eds. The Corsini Encyclopedia of Psychology 1. Hoboken, NJ:
Abate SM, Chekol YA, Basu B. Global prevalence and determinants of preoperative anxiety among surgical patients: a systematic review and meta-analysis. Int J Surg Open 2020; 25: 6-16. doi:10.1016/j.ijso.2020.05.010
Friedrich S, Reis S, Meybohm P, et al. Preoperative anxiety. Curr Opin Anaesthesiol 2022; 35: 674-8. doi:10.1097/ACO.0000000000001186
Athanassoglou V, Cozowicz C, Zhong H, et al. Association of perioperative midazolam use and complications: a population-based analysis. Reg Anesth Pain Med 2022; 47: 228-33. doi:10.1136/rapm-2021-102989
