Published December 27, 2018
Distraction May Be the Best Medicine
Lukas Pichler, MD, a research fellow at the Hospital for Special Surgery and NewYork-Presbyterian/Weill Cornell Medicine, and colleagues explored the impact of using distraction including videos viewed through audiovisual devices (AVDs: video goggles with headphones) during ambulatory arthroscopic surgery (menicscectomy) while the patient is awake and receiving regional anesthesia.
The research team enrolled 26 patients, all of whom received midazolam (2 mg) prior to receiving the spinal anesthetic. All patients were informed that they could request additional midazolam for sedation during the surgery, as needed. The 26 patients were randomly enrolled into two separate groups, with one group (n = 13) receiving the AVDs and the remaining group (n = 13) not receiving the devices. Pain and anxiety scores were evaluated using validated rating scales (State-Trait Anxiety Inventory scores) along with patient satisfaction (Client Satisfaction Questionnaire).
In this small study population, the outcome of additional use of sedatives was measured without statistical significance (P = 0.673). However, percentage differences were noted clinically with roughly 23% (n = 3) of patients using AVD requesting additional sedatives versus patients requesting sedatives who were not using AVD 38.5% (n = 5). Other outcomes evaluated included systolic and diastolic blood pressure changes from baseline (no statistically significant change was noted) and opioid use, both intraoperatively and postoperatively.
Although not statistically significant (P = 0.77 and P = 0.645, respectively), patients engaged in AVD used slightly higher oral morphine equivalents both intraoperatively (mean 3.5±12.5 standard deviation vs. 2.3±8.3, respectively) and postoperatively (mean 10.8±5 standard deviation vs. 9.8±6, respectively).
According to Pichler, “We demonstrated that performing ambulatory knee surgery under regional anesthesia in awake patients is feasible both with and without the use of audiovisual devices,” he said. “Then again, this was a pilot study, and it was not designed to demonstrate the superiority of audiovisual distraction. Therefore, future studies should use greater sample sizes to determine if audiovisual distraction can reduce the requirement for sedatives and improve postoperative outcomes.” Pichler emphasized that although this study was small, the findings of decreased need for additional sedation with the use of ADV seems promising, and that enrollment of subjects in an even larger study is currently underway.
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