Impact of Combined Immersive Virtual Reality and Spinal Anesthesia on Sedative Consumption in Total Knee Arthroplasty.

Abstract

Perioperative anxiety plays a key role in patients, particularly for postoperative recovery. Immersive virtual reality (VR), which has been developed in recent years for use in regional anesthesia, may help reduce this anxiety and limit intraoperative sedative consumption. The aim of this study was to objectively assess the impact of VR distraction on perioperative anxiety by evaluating sedative use during total knee arthroplasty (TKA) under spinal anesthesia (SA). A retrospective, single-center cohort study was conducted in patients receiving SA with a VR headset (group 1), compared to those receiving SA alone (group 2). The primary outcome measure was intraoperative sedative consumption. Secondary outcomes included perioperative complications (oxygen administration, hypotension) and analgesic consumption within five postoperative days (nefopam and oral morphine equivalent). Pearson's Chi-square and Wilcoxon-Mann-Whitney tests were used to assess categorical and continuous variables, respectively. There were 30 patients (group 1) who used a VR headset during the procedure, while 30 patients (group 2) received SA alone. The mean age was 71 years. There was a significant reduction in intraoperative sedative consumption in patients undergoing TKA under SA with VR (95% confidence interval [0.13 to 0.87], P = 0.018). A reduction in nefopam consumption within the five postoperative days was also observed (95% confidence interval [-0.1 to 33.7], P = 0.005). There were no significant differences found regarding oxygen administration, intraoperative hypotension, and length of hospital stay or oral morphine equivalent consumption within five postoperative days. The use of VR is an innovative approach that appears effective in reducing sedative consumption without increasing perioperative complications in patients undergoing TKA under SA. This promising study encourages further large-scale research to better assess the impact of VR in surgeries performed under SA. IV.