Audiovisual distraction as an adjunct to anxiety relief in hand surgery with regional anaesthesia

摘要

Dear Sir, Most patients undergoing surgery commonly experience anxiety, which is a natural reaction to the unpredictable and potentially threatening circumstances typical of the perioperative period (Badner et al., 1990). Excessive degrees of anxiety are accompanied by activation of the autonomic nervous system, leading to tachycardia, hypertension, increased respiratory rate, and higher levels of pain that may persist into the post-operative period. This can lead to prolonged healing and recovery times through activation of pro-inflammatory pathways (Sadideen et al., 2012). According to the broaden-and-build model, pain and anxiety are reduced when positive emotions are elicited (Fredrickson, 1998). The aim of the present study was to assess the efficacy of tablet computers as audiovisual distraction tools to alleviate anxiety in patients undergoing hand surgery. This study was approved by the local audit and ethics committee. Over a 3 month period, we carried out a prospective study of patients undergoing hand surgery at our tertiary referral centre. Patients undergoing routine acute and elective hand surgery under 60 minutes in duration with axillary brachial plexus anaesthetic blocks were invited to participate. Informed written consent was obtained from participants who agreed. Patients were excluded if they were under age 18 years, had severe hearing or visual impairments, were unable to understand the questionnaire (e.g., due to learning difficulties), had an anaesthetic block that was not 100% effective, or were administered pre-operative sedative medication. Patients were randomized to either standard care alone (control group) or tablet computers with standard care (intervention group) before entering the anaesthetic area. Participants in the intervention group had the use of an iPad (Apple Inc., Cupertino, California, USA) preloaded with a range of films and television shows. Sound was played through over-the-ear headphones. The device was made available before and after administration of regional anaesthesia and in the operating theatre throughout the procedure.