Sixty patients undergoing total knee arthroplasty with spinal anesthesia were randomized to receive either virtual reality hypnosis (VRH; n=30) or standard care (control; n=30). The primary outcome was intraoperative midazolam dose requirement. Secondary outcomes included functional recovery (QoR-15 score), anxiety, pain, fatigue, comfort, desaturation events, postoperative analgesic consumption, and recovery times, assessed up to 7 days after surgery. Overall, the VRH group required significantly less midazolam and had shorter post-anesthesia care unit (PACU) stay, along with lower fatigue and higher comfort ratings. However, quality of recovery, pain, and anxiety scores did not differ significantly. In conclusion, VRH modestly reduced sedation needs and improved some comfort measures, though without impact on overall recovery quality.