Does Triggering an Autonomous Sensory Meridian Response Reduce Pre-Operative Anxiety? A Randomized Placebo Controlled Trial

Background: Pre-operative anxiety is prevalent and associated with adverse patient outcomes. Many anxiolytic techniques have been utilized in the pre-operative setting, with varying degrees of success. The Autonomous Sensory Meridian Response (ASMR) is an increasingly popular method of relaxation used for anxiety reduction in general society. It is a non-invasive, inexpensive intervention with no known adverse effects. It has not been researched in a pre-operative setting. We aimed to investigate the effects of ASMR in the pre-operative patient population. Methods: This prospective, double-blind trial randomly allocated 50 participants into either a placebo or ASMR group. Pre-operative anxiety was compared before and after viewing specially formatted educational video information in either an ASMR or non-ASMR format with validated anxiety scales-Visual Analogue Scale (VAAS), Amsterdam Pre-operative Anxiety and Information Scale (APAIS) and State-Trait Anxiety Inventory. The physiological characteristics of heart rate and blood pressure were measured as secondary outcomes. Results: The control group demonstrated a reduction in pre-operative VAAS of 6.6 (p = 0.01) and 1.1 (p = 0.02) on the APAIS. The ASMR group had a reduction of APAIS of 1.9 (p = 0.005) and no change in the VAAS. Changes in State-Trait Anxiety Inventory for state anxiety score were the same in both groups. Increased trait anxiety was correlated with increased post-intervention VAAS and APAIS scores. There was no effect of pre-existing trait anxiety and pre-interventional anxiety on the efficacy of ASMR. Post-intervention, there was a significant decrease in mean systolic blood pressure by 2.7mmHg in ASMR group. In multivariable analysis, ASMR group had a drop of 3.9mmHg in post-intervention systolic blood pressure compared to placebo (p<0.05). Conclusion: While our findings are inconclusive, potential benefits of ASMR in reducing pre-operative anxiety should be further explored with a larger sample.