Intraoperative virtual reality distraction in TKA under spinal anesthesia: a preliminary study

Abstract

IntroductionThe effect of patient anxiety during the perioperative period has been shown to be of great importance in its influence on post-operative recovery. Over the last 10 years, virtual reality (VR) has been developed in anesthesia for patient's distraction by immersion. The aim of this study was to evaluate post-operative patient anxiety the day after TKA surgery under spinal anesthesia (SA) with or without VR distraction. Materials and methods A single-center, prospective cohort study was performed looking at patients undergoing TKA surgery under SA with a VR headset (group 1) compared with those undergoing the same procedure with standard protocol (group 2). Data using a validated scoring system looking at patient anxiety (STAI Y-1) were collected. Secondary endpoints were need for sedation during surgery, intraoperative complications (hypotension and oxygen need), postoperative pain and comfort scores (VAS) and patient satisfaction. Results Ten patients (group 1) received the VR headset during surgery and 10 (group 2) received the standard protocol established in our center. Average age was 73 years old. No difference was found in post-operative patient anxiety regarding to STAI Y-1 score (95% CI − 7 to 10, p = 0.71. There was a decrease of sedation and intra-operative adverse event as hypotension and oxygen requirement in group 1 (p < 0.0001, p = 0.015, p = 0.0054), and a significant increase in comfort score (p = 0.002). No difference in patient satisfaction was found. Conclusion Using VR for immersive distraction seemed to lead to no difference in patient anxiety in TKA under SA. Intraoperative adverse events were decreased, and post-operative comfort was increased. Patient satisfaction was not modified. This preliminary study is encouraging and gives us arguments to involve larger number of patients while exploring the various possibilities offered by VR.

Effects of virtual reality and acupressure interventions on pain, anxiety, vital signs and comfort in catheter extraction processes for patients undergoing coronary angiography: A randomized controlled trial

“…In the literature on VR interventions, Lahti et al (2020) reported that short‐term VR interventions are effective in reducing anxiety in patients undergoing surgery, while other studies have shown that VR interventions used in cardiology laboratories helped to reduce anxiety (Bruno et al, 2020; Morgen et al, 2021). In contrast to the findings of this study, Peuchot et al (2021) did not report a significant difference in postoperative anxiety scores in patients who underwent surgery, but they did observe a decrease in intraoperative adverse events. In terms of acupressure interventions, Aygin and Şen (2019) found that acupressure reduced the level of state anxiety in patients who underwent cardiac surgery.…”

The Emerging Role of Virtual Reality as an Adjunct to Procedural Sedation and Anesthesia: A Narrative Review

“…By reducing or in some cases eliminating the need for sedation, VR can lower the incidence of apnea [101]. In addition, studies of adults undergoing knee replacement have demonstrated improved intra-operative hemodynamics (reduced hypotension), decreased fentanyl requirement, and lower post-operative pain scores [102,103].…”

Application of Virtual Reality Systems in Bone Trauma Procedures

“…Immersive VR has also been exploited as a form of distraction therapy and adjunct to surgical anaesthesia to alleviate pain and anxiety and promote patient relaxation [ 106 , 107 , 108 ]. However, Peuchot et al reported that the use of VR for immersive distraction during total knee arthroplasty under spinal anaesthesia did not seem to reduce patient anxiety or alter patient satisfaction, although improvements in postoperative comfort and reductions in intraoperative complications were achieved [ 109 ]. In addition, as a rehabilitation tool, VR training, compared to sensory–motor training, was found to have a more favourable impact on pain, functional disability, and the modification of inflammatory biomarkers in post-traumatic osteoarthritis after an anterior cruciate ligament injury, although a negligible effect on bone morphogenic proteins expression was reported [ 110 ].…”

“…Meanwhile, cost remains a prohibitive barrier for high-fidelity bone trauma VR systems, especially in resource-limited settings. Nevertheless, future VR tools are expected to be cheaper, more user-friendly, and in tandem with technological advancements [ 38 , 109 ].…”