Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

The effect of audiovisual distraction on patient-controlled sedation under spinal anesthesia: a prospective, randomized trial

  • 14 Accesses


Audiovisual distraction (AVD) has been used to augment or replace procedural sedation. We investigated whether AVD in patients having total hip (THA) or total knee arthroplasty (TKA) under spinal anesthesia would reduce self-administered propofol consumption during surgery. 50 participants were randomized equally into a patient-controlled sedation (PCS) group or AVD group. All participants were given a spinal block and a propofol PCS device prior to surgery. In addition, Group AVD participants selected and watched a movie or documentary film on a tablet device with noise-cancelling headphones during surgery. The primary outcome of this study was total propofol consumption standardized as mcg/kg/min. Secondary outcomes evaluated increased supplemental oxygen use, rescue airway interventions, hypotension, disruptive movement events during surgery, sedation, and satisfaction with anesthesia scores. Historical clinician-controlled propofol usage at our institution over the previous 2 years were recorded. There was no significant difference in median propofol consumption between Groups PCS and AVD, 8.4 mcg/kg/min (1.6–18.9) vs 4 mcg/kg/min (0–9) (P = 0.29), respectively. Historical clinician-controlled usage of propofol demonstrated a median of 39.3 mcg/kg/min (29.2–51.2). There were few differences in the secondary outcome measures. The use of AVD did not reduce patient-controlled propofol consumption in patients having a THA or TKA surgery under spinal anesthesia.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Perlas A, Chan VW, Beattie S. Anesthesia technique and mortality after total hip or knee arthroplasty: a retrospective, propensity score-matched cohort study. Anesthesiology. 2016;125:724–31. https://doi.org/10.1097/ALN.0000000000001248.

  2. 2.

    Johnson RL, Kopp SL, Burkle CM, et al. Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. Br J Anaesth. 2016;116:163–76. https://doi.org/10.1093/bja/aev455.

  3. 3.

    Diprivan®(propofol) [package insert]. Lake Zurich, IL: Fresenius Kabi; 2017.

  4. 4.

    Chan PY, Scharf S. Virtual reality as an adjunctive nonpharmacological sedative during orthopedic surgery under regional anesthesia: a pilot and feasibility study. Anesth Analg. 2017;125:1200–2. https://doi.org/10.1213/ANE.0000000000002169.

  5. 5.

    Malloy KM, Milling LS. The effectiveness of virtual reality distraction for pain reduction: a systematic review. Clin Psychol Rev. 2010;30:1011–8. https://doi.org/10.1016/j.cpr.2010.07.001.

  6. 6.

    Hoffman HG, Patterson DR, Carrougher GJ. Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study. Clin J Pain. 2000;16:244.

  7. 7.

    Lepage C, Drolet P, Girard M, Grenier Y, DeGagné R. Music decreases sedative requirements during spinal anesthesia. Anesth Analg. 2001;93:912–6. https://doi.org/10.1097/00000539-200110000-00022.

  8. 8.

    Ayoub CM, Rizk LB, Yaacoub CI, Gaal D, Kain ZN. Music and ambient operating room noise in patients undergoing spinal anesthesia. Anesth Anal. 2005;100:1316–9. https://doi.org/10.1213/01.ANE.0000153014.46893.9B.

  9. 9.

    Marsdin E, Noble JG, Reynard JM, Turney BW. Audiovisual distraction reduces pain perception during shockwave lithotripsy. J Endourol. 2012;26:531–4. https://doi.org/10.1089/end.2011.0430.

  10. 10.

    Drahota A, Galloway E, Stores R, Ward D, Severs M, Dean T. Audiovisual distraction as an adjunct to pain and anxiety relief during minor surgery. Foot (Edinb). 2008;18:211–9. https://doi.org/10.1016/j.foot.2008.06.001.

  11. 11.

    Park WY, Watkins PA. Patient-controlled sedation during epidural anesthesia. Anesth Analg. 1991;72:304–7. https://doi.org/10.1213/00000539-199103000-00005.

  12. 12.

    Kreienbuhl L, Elia N, Pfeil-Beun E, Walder B, Tramèr MR. Patient-controlled versus clinician-controlled sedation with propofol: Systematic review and meta-analysis with trial sequential analyses. Anesth Analg. 2018;127:873–9. https://doi.org/10.1213/ANE.0000000000003361.

  13. 13.

    Rudkin GE, Osborne GA, Finn BP, Jarvis DA, Vickers D. Intra-operative patient-controlled sedation. Comparison of patient-controlled propofol with patient-controlled midazolam. Anaesthesia. 1992;47:376–81. https://doi.org/10.1111/j.1365-2044.1992.tb02216.x.

  14. 14.

    Coimbra C, Choinière M, Hemmerling TM. Patient-controlled sedation using propofol for dressing changes in burn patients: a dose-finding study. Anesth Analg. 2003;97:839–42. https://doi.org/10.1213/01.ane.0000074236.76333.53.

  15. 15.

    Newson C, Joshi GP, Victory R, White PF. Comparison of propofol administration techniques for sedation during monitored anesthesia care. Anesth Analg. 1995;81:486–91. https://doi.org/10.1097/00000539-199509000-00010.

  16. 16.

    Chernik DA, Gillings D, Laine H, et al. Validity and reliability of the Observer’s Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol. 1990;10:244–51.

  17. 17.

    Dexter F, Aker J, Wright WA. Development of a measure of patient satisfaction with monitored anesthesia care; the Iowa Satisfaction with Anesthesia Scale. Anesthesiology. 1997;87:865–73. https://doi.org/10.1097/00000542-199710000-00021.

Download references


The authors would like to recognize University of Utah anesthesiology residents Drs. Landon Woolf, Heather Henry, Jared Hicks and Kevin Conrad for their contributions during the data collection phase of this study. We would also like to acknowledge Nathan Pace, MD, MStat and Angela Presson, PhD for their assistance with the statistical analysis of our data. The Iowa Satisfaction with Anesthesia Scale is copyrighted by Franklin Dexter and the University of Iowa Research Foundation. This study was funded by the Departments of Anesthesiology and Orthopaedics at the University of Utah School of Medicine, Salt Lake City, UT.


Funding for this study was provided entirely by the Department of Anesthesiology and the Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.

Author information

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AWM, MJB, MG, EWP, LN, CMA, ARS, JG, KBJ. The first draft of the manuscript was written by AW Meier and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Correspondence to Adam W. Meier.

Ethics declarations

Conflict of interest

The authors declare no financial or personal conflicts of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the University of Utah Institutional Review Board (IRB102391) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all study participants prior to participating in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 17 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Meier, A.W., Buys, M.J., Gill, M. et al. The effect of audiovisual distraction on patient-controlled sedation under spinal anesthesia: a prospective, randomized trial. J Clin Monit Comput (2020). https://doi.org/10.1007/s10877-020-00478-y

Download citation


  • Technology
  • Clinical pharmacology
  • Regional anesthesia