Influence of Virtual Reality Devices on Pain and Anxiety in Patients Undergoing Cystoscopy Performed under Local Anaesthesia

Abstract

Background: Bladder cancer is one of the most common malignancies. Its diagnosis is based on transurethral cystoscopy. Virtual reality (VR) is a three-dimensional world generated through the projection of images, the emission of sounds and other stimuli. VR has been proven to be a very effective “distractor” and, thus, a useful tool in managing pain. The aim of this study was to determine whether the use of VR sets is technically feasible during the cystoscopy and whether the use of VR devices would reduce the degree of ailments associated with the procedure; Methods: The study prospectively included both men and women who qualified for rigid cystoscopy due to both primary and follow-up diagnostics. The study group underwent rigid cystoscopy with the VR set and the control group underwent the procedure without the VR set. Patients enrolled in both groups were subjected to blood pressure, heart rate and saturation measurements before, during and after the procedure. Additionally, the patients were asked to describe the severity of fear, pain sensations and nausea associated with the procedure. Non-verbal pain manifestations were assessed using the adult adjusted Faces, Legs, Activity, Cry and Consolability (FLACC) scale; Results: The study population included 103 patients (74M/29F; mean age 64.4 years). Pain intensity differed significantly between the groups, reaching lower values in the VR group. In all analyzed subgroups the use of the VR set was associated with higher levels of nausea. The mean FLACC score reached higher values for patients without the VR set. Blood pressure as well as heart rate increased during the procedure and decreased afterwards. The increase in systolic blood pressure and pulse rate was statistically higher in the control group; Conclusions: This study confirmed that cystoscopy is associated with considerable preprocedural fear and severe pain. Blood pressure and heart rate rise significantly during the cystoscopy. VR sets can lower pain perception during cystoscopy, but they may cause moderate nausea.

Can virtual reality enhance the patient experience during awake invasive procedures? A systematic review of randomized controlled trials

“…Ten of the 13 studies demonstrated a favorable effect on pain with the use of VR compared with standard intraprocedural care (77% (95% CI: 38%-100%), P = 0.046). 5,16,17,29,41,42,46,47,55,56 The overall median effect size was −0.33 (95% CI: −0.76 to 0.08) (I 2 = 66%) for the VR group compared with the control. The direction of effect and median effect sizes within the “incision” (−0.39 [95% CI: −0.98 to 0.20] [I 2 = 46%]) and “endoscopic” (−0.33 [95% CI: −0.72 to 0.06] [I 2 = 73%]) subgroups were similar, indicating a lack of subgroup difference.…”

“…5,81 Thirteen trials displayed relaxing, nature-related content on the VR headsets. 1,5,11,17,41,42,46,47,55,56,72,78,81 Two studies included only female patients, 1,17 whereas 1 study included only male patients. 83 No significant differences in age were noted between the VR and control groups.…”

“…83 No significant differences in age were noted between the VR and control groups. Nine studies involved endoscopic procedures, 11,16,17,29,47,55,56,81,83 whereas the remaining 7 studies involved an incision which breached the skin barrier. 1,5,41,42,46,72,78 Patients received local anesthesia (LA) in 8 studies 5,11,29,41,46,47,56,83 and regional anesthesia (RA) in 4 studies.…”

“…Nine studies involved endoscopic procedures, 11,16,17,29,47,55,56,81,83 whereas the remaining 7 studies involved an incision which breached the skin barrier. 1,5,41,42,46,72,78 Patients received local anesthesia (LA) in 8 studies 5,11,29,41,46,47,56,83 and regional anesthesia (RA) in 4 studies. 1,42,72,78 Patients in the remaining studies did not receive locoregional anesthesia (LRA), instead they were offered analgesia or conscious sedation.…”

“…Thirteen of the 16 RCTs reported on the patient's experience of pain during the procedure (Table 6). 5,11,16,17,29,41,42,46,47,55,56,81,83 Twelve studies used 11-point VASs to measure pain. 5,11,16,17,29,41,46,47,55,56,81,83 A higher score indicated a greater level of pain.…”