{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:44Z","timestamp":1792787324691,"version":"4.5.0"},"reference-count":30,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/100018288","name":"AstraZeneca Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018288","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005026","name":"Belgium Foundation Against Cancer","doi-asserted-by":"crossref","award":["2017064"],"award-info":[{"award-number":["2017064"]}],"id":[{"id":"10.13039\/501100005026","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100005026","name":"Belgium Foundation Against Cancer","doi-asserted-by":"crossref","award":["C\/2020\/1357"],"award-info":[{"award-number":["C\/2020\/1357"]}],"id":[{"id":"10.13039\/501100005026","id-type":"DOI","asserted-by":"crossref"}]},{"name":"University and University Hospital of Liege and its Department of Anesthesia and Intensive Care Medicine and Algology Interdisciplinary Centre"},{"name":"European Foundation of Biomedical Research","award":["BioWin Health Cluster framework"],"award-info":[{"award-number":["BioWin Health Cluster framework"]}]},{"DOI":"10.13039\/501100006673","name":"Fonds L\u00e9on Fredericq","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006673","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,2,20]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Perioperative psychological stress and pharmacological anxiolysis can negatively affect the quality of recovery after total knee arthroplasty. We aimed to assess whether hypnosis combined with virtual reality could reduce intraoperative pharmacological sedation and improve quality of recovery after total knee arthroplasty surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective randomized clinical trial, 60 patients scheduled for total knee arthroplasty with spinal anesthesia were randomly divided into 2 groups of 30 patients each. Intraoperatively, intermittent boluses of midazolam 1\u2009mg were administered at 5\u2009min intervals at the patient\u2019s request, with a maximum driven by the clinical assessment of sedation depth. During surgery, patients received standard care (group control) or virtual reality hypnosis (group VRH). An unblinded observer recorded the total dose of midazolam administered during surgery, and changes in the Quality-of-Recovery 15-item score, comfort, fatigue, pain and anxiety before and 1, 3 and 7\u2009days after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients in the VRH group required a lower dose of midazolam (mg; median (range)) intraoperatively (group VRH: 0 (0\u20134) and group control: 2 (0\u20139), p&lt;0.001). Quality-of-Recovery 15-item, anxiety, and pain were similar between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In total knee arthroplasty with spinal anesthesia, VRH reduces the requirement for intraoperative pharmacological sedation, without a change in the quality of recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05707234\">NCT05707234<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  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