Virtual Reality Hypnosis Distraction Utility to Improve the Quality of Routine Procedure-related Pain During Preoperative Locoregional Anaesthesia

Background Regional anesthesia has many advantages but it might be a stressful and painful experience and the anaesthetist has to establish all the necessary measures to maintain patient's comfort and cooperation. In practice, this ideal situation may be the most challenging part of the regional anesthetic practice. Usually, the anesthetist administers a pharmacologic intravenous sedation, including opioids and benzodiazepines to achieve patient's comfort. These medications are not benign, and disadvantages include possible unpredictable response, adverse effects, and hindered cooperation.

Among the non-pharmacologic techniques which may be used to improve the patient's comfort, decrease anxiety and procedure related pain, hypnosis and virtual reality distraction are increasingly used.

In spite of the encouraging scientific and clinical findings, hypnosis for analgesia is not universally used in medical centers. Its widespread use has been limited by factors such as the advanced expertise, time and effort required by clinicians to provide hypnosis, and the commitment required by patients to engage in hypnosis. It is a challenge to make hypnosis a standard part of care in this environment.

Improvements in technologies made virtual reality (VR) distraction a unique practical tool to provide an immersive, multisensory and three-dimensional (3D) environment that creates a sense of presence which enables to modify the perception of reality and to capture a greater degree of attention. Several theories have been proposed to explain how distraction may inhibit or decrease perception of pain by capturing a greater degree of attention. The "virtual reality analgesia" (= analgesia produces by virtual reality) is a product of the attentional distraction. Hoffmann et al. explained that there is a limit to the conscious attentional resources humans have available to process large amounts of incoming information. Conscious attention is required for pain perception. Hoffmann et al. theorize that the more immersive the VR system, the more attention will be drawn into the virtual world, leaving less attention available to process nociceptive signals.

Until now, VR shows an interest in numerous clinical applications (to help treat anxiety disorders, control pain, support physical rehabilitation, and distract patients during wound care) VR technology guides the patient through the same steps used when hypnosis is induced through an interpersonal process. With attentional mechanisms as a common denominator, the attention-captivating qualities of virtual reality and the suggestion inherent in hypnosis, the potential for a synergistic effect between these modalities is significant.