Virtual reality immersion compared to monitored anesthesia care for hand surgery: A randomized controlled trial

Abstract

Introduction Common anesthesia practice for hand surgery combines a preoperative regional anesthetic and intraoperative monitored anesthesia care (MAC). Despite adequate regional anesthesia, patients may receive doses of intraoperative sedatives which can result in oversedation and potentially avoidable complications. VR could prove to be a valuable tool for patients and providers by distracting the mind from processing noxious stimuli resulting in minimized sedative use and reduced risk of oversedation without negatively impacting patient satisfaction. Our hypothesis was that intraoperative VR use reduces sedative dosing during elective hand surgery without detracting from patient satisfaction as compared to a usual care control. Methods Forty adults undergoing hand surgery were randomized to receive either intraoperative VR in addition to MAC, or usual MAC. Patients in both groups received preoperative regional anesthesia at provider discretion. Intraoperatively, the VR group viewed programming of their choice via a head-mounted display. The primary outcome was intraoperative propofol dose per hour (mg · hr-1). Secondary outcomes included patient reported pain and anxiety, overall satisfaction, functional outcome, and post anesthesia care unit (PACU) length of stay (LOS). Results Of the 40 enrolled patients, 34 completed the perioperative portion of the trial. VR group patients received significantly less propofol per hour than the control group (Mean (±SD): 125.3 (±296.0) vs 750.6 (±334.6) mg · hr-1, p<0.001). There were no significant differences between groups in patient reported overall satisfaction, (0–100 scale, Median (IQR) 92 (77–100) vs 100 (100–100), VR vs control, p = 0.087). There were no significant differences between groups in PACU pain scores, perioperative opioid analgesic dose, or in postoperative functional outcome. PACU LOS was significantly decreased in the VR group (53.0 (43.0–72.0) vs 75.0 (57.5–89.0) min, p = 0.018). Conclusion VR immersion during hand surgery led to significant reductions in intraoperative propofol dose and PACU LOS without negatively impacting key patient reported outcomes.

The Role of Immersive Virtual Reality on the Patient Experience and Future Applications in Spinal Care

“…There was significantly less propofol use per hour in the VR group compared with the control group (125.3 ± 296.0 mg/h vs 750.6 ± 334.6 mg/h, P < 0.001). In this trial, VR immersion was able to significantly reduce intraoperative sedatives without negatively impacting patient satisfaction and outcomes 18. Importantly, this reduced sedation requirements contributed to shorter PACU length of stay among patients in the VR group compared with the control (75.0 vs 53.0 minutes, P = .018).…”

“…In this trial, VR immersion was able to significantly reduce intraoperative sedatives without negatively impacting patient satisfaction and outcomes. 18 Importantly, this reduced sedation requirements contributed to shorter PACU length of stay among patients in the VR group compared with the control (75.0 vs 53.0 minutes, P = .018). Although a difference of 22 minutes may seem marginal, optimization of PACU requirements may help substantially improve perioperative efficiency and demonstrate an additive effect across several surgical cases per day.…”

How Real Are the Effects of Virtual Reality in Decreasing Acute Pain?

“…11 Other studies have used VR as an adjunct to spinal anesthesia for major surgery (eg, total knee arthroplasty, total hip arthroplasty, and hand surgery) or as monitored anesthesia care for minor procedures (cystoscopy), wherein we observe that VR may influence dose of propofol used but is not associated with pain or anxiety reduction. 12,13 Below, we discuss specific considerations and challenges pertaining to acute pain, and reflect on them to discuss the study by Araujo-Duran et al…”

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 ].…”