Influence of virtual reality with or without hypnosis on patient-related experience and functional recovery in outpatient foot surgery with regional anesthesia: a randomized controlled trial.

Introduction: Perioperative psychological stress significantly influences recovery after surgery. Sciatic nerve and ankle blocks are commonly used techniques for achieving postoperative analgesia in outpatient foot surgery. However, these procedures can cause discomfort for patients, potentially affecting their postoperative functional recovery. This study aims to assess the impact of virtual reality with or without hypnosis on patient satisfaction and postoperative functional recovery in patients undergoing peripheral nerve blocks for outpatient foot surgery.

Methods: A prospective randomized clinical trial was conducted involving 57 patients scheduled for outpatient foot surgery with combined sciatic popliteal and ankle nerve blocks. Patients were randomly assigned to one of three groups: group C (usual care with intravenous midazolam), group VR (virtual reality immersion through glasses and headsets), or group VRH (virtual reality immersion with prerecorded hypnosis-sedation session). Patient satisfaction with the regional anesthesia experience (evaluated using the EVAN-LR score, Evaluation du Vécu de l'Anesthésie LocoRégionale Score) was assessed 4 hours after surgery. The quality of recovery 15-item and perioperative anxiety (Numeric Rate Scale (NRS) and six-item Spielberger State-Trait Anxiety Inventory (STAI-6)) were evaluated at fixed time points: 1 hour before and after surgery for NRS-anxiety and STAI-6 and 1 day before surgery, and at day 1 and day 3 postoperatively for Quality-of-Recovery-15 items.

Results: Postoperative EVAN-LR scores were similar across groups (group C: 91 (86.5, 93.5) vs group VR: 90 (87.5, 93.5) vs group VRH: 91 (89, 93); p=0.64). There were no significant differences in the evolution of quality of recovery 15-item (p=0.25) nor perioperative anxiety (NRS and STAI-6: p=0.18 and p=0.14, respectively) among the groups.

Discussion: Virtual reality with or without hypnosis did not significantly impact satisfaction with regional anesthesia techniques in outpatient foot surgery. Additionally, there were no differences observed among the groups in terms of functional recovery during the first three postoperative days.

Trial Registration Number: NCT05558449.