Nonpharmacological Adjuncts to Reduce Perioperative Anxiety and Pain for Awake Gynecological Procedures: A Scoping Review

Awake gynecological procedures are common and frequently associated with perioperative anxiety and pain. Standard care typically relies on anesthetics and analgesics; however, their direct effectiveness for anxiety and distress is variable. Interest in nonpharmacological adjuncts that may enhance patient comfort and other perioperative outcomes has grown. A wide range of nonpharmacological interventions have been studied across gynecological procedures, yet no comprehensive review has summarized which interventions have been used for which procedures and at what perioperative time points. Thus, this scoping review aimed to identify and synthesize the literature on nonpharmacological interventions for reducing perioperative anxiety and pain during awake gynecological procedures, describe feasibility, and summarize patterns in effectiveness. Ovid MEDLINE, Embase, SCOPUS, Cochrane CENTRAL, and Google Scholar were searched from inception to December 3, 2024. Eligible studies included randomized and nonrandomized controlled trials, and pilot, feasibility, or case studies evaluating preoperative or intraoperative nonpharmacological adjuncts for anxiety, distress, and/or pain. Ninety-one studies (105 interventions) were included, with 19 unique intervention types. The most common intervention categories, based on the number of interventions, were virtual reality (VR; 22/105, 21.0%), music therapy (17/105, 16.2%), and acupuncture (12/105, 11.4%). Many studies involved therapeutic and diagnostic gynecological procedures (33/91, 36.3%, eg, hysteroscopies). Most studies were randomized controlled trials (63/91, 69.2%) comparing interventions with standard care (78/105, 74.3%). Across outcomes, 84 interventions assessed pain (84/105, 80.0%), and 65.5% reported reductions in pain (55/84). Of the interventions that assessed anxiety (72/105, 68.6%), 66.7% reported reductions in anxiety relative to controls or baseline levels (48/72). Interventions were generally feasible, with acceptability and satisfaction comparable to standard of care or comparators. Overall, although many nonpharmacological interventions appear promising in managing perioperative anxiety and pain across diverse gynecological procedures, VR and music therapy demonstrated particular promise given their consistent patterns in reducing anxiety and pain, as well as scalability and feasibility. Major gynecological surgeries, where anesthesiology is primarily involved, may represent suitable targets demonstrating consistently positive outcomes for both pain and anxiety, even in contexts where nonpharmacological methods replaced pharmacological approaches. While encouraging, these findings should be interpreted with caution, given the potential publication bias. Future research should include targeted feasibility studies and meta-analytic syntheses to evaluate the robustness and clinical significance of these effects.