Dana Patrascu, Physician in anesthesia-resuscitation, Orthopedic Surgery Department, Croix-Rousse Lyon Hospital
Psychological pre-conditioning by virtual reality in preoperative of a total knee prosthesis
Our work over the past 6 years has been directed towards the development of improved rehabilitation after prosthetic knee and hip surgery. A modification of the surgical approaches and the anesthetic strategy and a paradigm shift concerning the patient journey, allowed us to significantly reduce postoperative pain and facilitate the patient's clinical recovery after knee arthroplasty.
Despite the accumulated experience and the improvement of operative techniques and perioperative protocols, we have noticed a certain variability in the functional result and the satisfaction of our patients. While the majority of patients recover without too many adverse effects or significant pain, some patients sometimes remain painful and unsatisfied postoperatively, despite optimal analgesic treatment and a similar course to other patients. An in-depth reflection on the psychological component of pain (perception/expression) and its link with preoperative anxiety, leads us today to address the problem upstream, in the preoperative care of the patient.
In response to this individual variability in terms of results and in the spirit of continuous improvement of the care offered to our patients, we are trying to set up in our service a project of psychological preconditioning by virtual reality (VR) in preoperative total knee prosthesis surgery. The principle consists of a multi-sensorial immersion of the patient(s) in his/her course of care by means of virtual reality by offering him an anticipated projection into the intraoperative experience, familiarization with the premises and the nursing staff, a repetition of practical information on hospitalization systematized in stages. To support this immersion, an element of communication was worked on at length by a psychologist and built on "theoretical-clinical" knowledge in psychology and psychopathology concerning anguish and anxiety in the face of surgery. A reflection was carried out about the anxiety of intrusion, penetration and break-in which require the establishment of physical and psychological envelopes sufficiently adjusted to allow the patient to contain these anxieties, without forgetting the esteem of self and the narcissistic construction of the subject which come into play in the perspective of post-surgery recovery. In practice, a 6-minute immersive session with a VR device made available by the Lyon Deepsen Company is offered to the patient by the RAC nurse coordinator, immediately after the visit with the surgeon and before the consultation with the anesthesiologist.
Our hypothesis is that this immersion in VR allows a more efficient and personalized preoperative preparation of the patient compared to the conventional procedure, with a decrease in preoperative anxiety scores, a decrease in the consumption of pre- and intraoperative anxiolytic and sedative drugs, a decrease in postoperative pain and an increase in postoperative recovery and patient satisfaction. We also believe that a collective benefit can be envisaged, based on the principle that the same type of preparation can be reproduced before performing any type of invasive medico-surgical act that is potentially stressful and painful for the patient.
Virtual reality is a technical means that evolves rapidly and easily adapts to any type of specialty, either in real personalized mode or in computer-generated images that are easier to create, modify and adapt over time