Regional anesthesia and pain medicineRandomized Controlled Trial
06 May 2025
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.
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.
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.
In total knee arthroplasty with spinal anesthesia, VRH reduces the requirement for intraoperative pharmacological sedation, without a change in the quality of recovery.
NCT05707234.
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.
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