Arthroscopy is one of the most common procedures used in orthopedic surgery for diagnostic evaluation and treatment of intra-articular pathologies. Arthroscopic methods are frequently used in the surgical treatment of various conditions such as meniscus and cruciate ligament injuries of the knee joint, one of the most frequently damaged parts of the human body [1]. During the arthroscopy procedure, the joint, which is the surgical intervention area, does not need to be opened with a wide incision, and the operation can be performed with the camera and auxiliary tools placed through a few holes in the skin [2].

Arthroscopy is a minimally invasive procedure compared to traditional knee surgery. Spinal anesthesia can be used during the procedure; however, it causes pain and affects procedure tolerance. As an integral part of surgical procedures, pain is an experience that negatively affects physical and mental well-being [3,4]. With the increase in stress level as a result of pain, the sympathetic nervous system is stimulated and vital functions may be affected [3,5], which disturbs the patient's comfort during the procedure and decreases the quality of satisfaction. Patients under spinal anesthesia experience increased levels of anxiety compared to those under general anesthesia during surgery for several reasons. They remain awake throughout the surgery and are exposed to various senses such as the sounds of equipment in the operating room, the conversations of the medical staff, and the chill and odors generated during the surgery [6,7]. Therefore, patients may prefer using general anesthesia to local anesthesia and patients experience narcotic-related complications such as sedation, respiratory depression, nausea, vomiting, and constipation following the overuse of opioid analgesics [4,8,9]. To avoid the dose of use, side effects of sedative pharmacological agents and increase patient satisfaction, non-pharmacological methods could be used along with pharmacological methods [5,8,[10], [11], [12], [13]].

Recent research suggests the use of non-pharmacologic methods in combination with medical treatment to increase pain tolerance and improve patient comfort and satisfaction in patients affected by surgical interventions. These methods do not cause any harm to patients unlike pharmacologic agents and they may help to maintain physiological parameters such as blood pressure, respiration, and pulse rate at normal levels and increase comfort and satisfaction levels. Non-pharmacological methods such as music therapy, white noise therapy, and virtual reality goggles can be used to distract the patient from the source of stress and focus on other thoughts [[8], [9], [10], [11], [12], [13], [14]]. White noise (WN), one of the methods used in our research, is a constant monotonous sound consisting of a combination of different frequencies of sounds coming from the environment, such as the sound of wind over trees, waterfalls, radio waves, or ocean waves. Listening to white noise distracts the patient from external problems, the patient's attention is focused on the soothing and relaxing sound, and the person feels relaxed as a result of decreased stimulation of the sympathetic system [3,13,15,16]. In our research, a white noise mobile application, which was found to have a calming effect in a previous study, was used to play white noise [16]. In this mobile application, noise sounds resembling thunder, continuous rain, rotating fan, and powerful waterfall, etc. are categorized as white, pink, brown, blue, and purple.

Another method used in the research was virtual reality. Virtual reality (VR) is an advanced computer technology and a new technique used in the field of health to relieve pain and relax the patient, allowing them to interact with a 360-degree virtual environment using a headset device. It is seen that the painful or emotionally stressful stimuli coming from the outside world of the individual are reduced in the VR environment in which they interact, and their attention focuses on this environment [11,17]. In our research, we used a VR video with nature sounds that gives the feeling of being in a calming virtual rainforest environment with virtual reality goggles. Exposure to such natural stimuli is known to contribute significantly to improving people's mood and mental and physical health [18]. Many studies have shown that virtual reality and white noise reduce pain, improve patient comfort and satisfaction, and are effective in regulating vital signs [[8], [9], [10], [11], [12], [13], [14]].

It is thought that VR and WN applications can be used as complementary methods to support along with standard spinal anesthesia procedure during surgery. There is no study in the literature assessing the use of these methods together during arthroscopy.

The aim of this study was to investigate the effect of VRF and WN applications on patient satisfaction, tolerance, comfort, and vital signs in arthroscopic knee surgery patients.

H0-1

There is no significant difference regarding the mean satisfaction scores measured during the arthroscopy procedure between the experimental and control groups.

H0-2

There is no significant difference regarding the mean tolerance scores measured during the arthroscopy procedure between the experimental groups and the control group.

H0-3

There is no significant difference regarding the mean comfort scores measured during the arthroscopy procedure between the experimental and control groups.

H0-4

There is no significant difference regarding the mean scores of vital signs measured during the arthroscopy procedure between the experimental and control groups.

H1-1

There is a significant difference regarding the mean satisfaction scores measured during the arthroscopy procedure between the experimental groups and the control group.

H1-2

There is a significant difference regarding the mean tolerance scores measured during the arthroscopy procedure between the experimental groups and the control group.

H1-3

There is a significant difference regarding the mean comfort scores measured during the arthroscopy procedure between the experimental and control groups.

H1-4

There is a significant difference regarding the mean scores of vital signs measured during the arthroscopy procedure between the experimental and control groups.