Audiovisual distraction as an adjunct to pain and anxiety relief during minor surgery

Background: Minor surgery for ingrown toenails can provoke anxiety and the anaesthetic injection can be acutely painful. Distraction techniques may reduce the associated pain and anxiety. Objective: To investigate an audiovisual distraction (Bedscapes™) on pain and anxiety during minor surgery for the correction of ingrown toenail. Method: In a randomised controlled trial, patients (N = 152) with ingrown toenails requiring surgical correction under local anaesthesia were allocated to receive Bedscapes™ + standard care or standard care alone. Pain levels due to local anaesthetic injection were assessed post-procedure, and anxiety levels were assessed pre- and post-procedure in both groups. Follow-up focus groups were conducted with 14 patients allocated to the Bedscapes™ group, and one-to-one interviews were held with four podiatrists. Results: Participants with high pre-procedure anxiety scores experienced greater pain on injection, and older patients reported lower pain than younger patients, regardless of group allocation. Bedscapes™ did not reduce pain or anxiety, and was apparently no more effective than interpersonal interaction between podiatry staff and the patient. Conclusions: Pain of injected anaesthesia correlates closely with pre-operative anxiety. Formal audiovisual distraction has no added benefit over interpersonal interaction in the alleviation of pain and anxiety in patients undergoing nail surgery.