Abstract
Background - High levels of anxiety and pain during conscious surgery are associated with poorer post-surgical outcomes. This thesis aimed to compare the effectiveness of intraoperative distraction interventions for anxiety and pain management during minimally invasive surgery under local anaesthetic, the impact on 3 month outcomes and patient's experiences of conscious surgery. Methods - Literature and systematic reviews explored the current literature surrounding conscious surgery. Two randomised controlled trials investigated the impact of intra-operative distraction interventions on pain and anxiety during conscious surgery. Analyses of postoperative outcomes including multiple regression and analyses of covariance explored the relationships between intra-operative and post-operative outcomes at 3 months post-surgery. A qualitative analysis explored patient experience of minimally invasive surgery under local anaesthetic. Results - Intra-operative distractions including touch, audiovisual stimuli and interaction with nurses resulted in significantly lower reports of intra-operative anxiety and pain than treatment as usual. Participants who interacted with nurses during surgery reported significantly greater improvements in quality of life at 3 months post-surgery than those who received treatment as usual. Intra-operative distractions had no impact on the course of post-operative pain, return to work or satisfaction with treatment. The symptoms of varicose veins negatively impacted upon quality of life and participants felt unprepared for the experience of surgery. Relationships improved patient experience during surgery and improvements in physical and psychological wellbeing were reported at 3 months following surgery. Conclusions - The use of simple distraction techniques, particularly interacting with nurses, intra-operative touch or audiovisual stimuli used during surgery significantly improved patient experience. Participant satisfaction with surgery was high but there is scope to improve the provision of pre-operative information patients receive to increase their understanding of surgery. Relationships with others influenced all stages of the operative process.