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

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. It was placed on a mobile stand within easy reach of the unoperated arm, enabling patients to change programmes and adjust volume independently before and during each procedure. Intra-operative patient positioning was unaffected. In the control group, the standard care that patients received involved routine interpersonal interactions between theatre staff and patient, but not a dedicated member of staff providing distracting conversation during surgery. Anxiety level was quantified objectively by measuring the patient’s respiratory rate (RR) and heart rate (HR) and subjectively by asking them to rate their anxiety on a visual analogue scale (VAS) from 0 (none) to100 (most severe) (Kindler et al., 2000). In both groups, measurements were taken pre-operatively before the administration of anaesthesia, intraoperatively 15 minutes into the procedure, and postoperatively after entering the recovery area. The unpaired t-test and Student’s t-test were used to analyze the results. Forty patients were eligible and consented to participate; 26 were male and 14 female. The mean age was 42 (20–71) years. There were 22 patients in the intervention group (15 trauma, seven elective) and 18 patients in the control group (11 trauma, seven elective). The differences in demographics between the groups were not significant (p > 0.05). There was no significant difference in anxiety preoperatively (Table 1). Intra-operatively, patients in the intervention group experienced lower anxiety than the control group with lower VAS and RR results. Postoperatively, the intervention group continued to have lower subjective anxiety than the control group. The differences in HR between the groups were not significant. The changes in patient anxiety within each group were significant between the transition from the preto intra-operative period. This is the first study to investigate the effect of using tablet computers to alleviate patient anxiety in surgery. Our results demonstrate tablet usage significantly lowers anxiety intraand post-operatively. Interestingly, both groups demonstrated similar levels of anxiety pre-operatively. This may have been due to the short period the intervention group had to engage with the tablets before the first measurements were taken, possibly not allowing enough time for the anxiolytic effect to work. Letters to the Editor Short Report Letters 481724 JHS38910.1177/1753193413481724The Journal of Hand SurgeryShort report letters 2013