Virtual Reality Improves the Patient Experience during Wide-Awake Local Anesthesia No Tourniquet Hand Surgery: A Single-Blind, Randomized, Prospective Study

Abstract

Summary: Wide-awake local anesthesia no tourniquet surgery has been shown to decrease cost and hospital length of stay. The authors studied the use of virtual reality during wide-awake local anesthesia no tourniquet outpatient upper extremity surgery to assess its effect on patient pain, anxiety and fun. Patients undergoing wide-awake local anesthesia no tourniquet surgery were randomized to use (virtual reality) or not use (non–virtual reality) virtual reality during their procedures. Pain, fun, and anxiety were measured with a Likert scale at several time points, as were blood pressure and heart rate. A postoperative questionnaire was used to assess overall satisfaction. Virtual reality patients exhibited lower anxiety scores during injection, during the procedure, and at the end of the procedure. There were no differences in blood pressure, heart rate, or pain scores. Compared with non–virtual reality patients, virtual reality patients’ fun scores were higher. Virtual reality patients felt the experience helped them to relax, and they would recommend virtual reality–assisted wide-awake local anesthesia no tourniquet surgery. Among patients with self-reported preexisting anxiety, virtual reality patients had lower pain and anxiety scores during injection of local anesthesia compared with non–virtual reality patients. This study demonstrates that readily available virtual reality hardware and software can provide a virtual reality experience that reduces patient anxiety both during the injection of local anesthesia and during the surgical procedure. (Plast. Reconstr. Surg. 144: 408, 2019.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Immersive Virtual Reality Used as Adjunct Anesthesia for Conversion Total Hip Arthroplasty in a 100-Year-Old Patient

“…Perhaps most encouraging, our elderly patient reported excitement to use the IVR technology and a fulfilled expectation of less anxiety and satisfaction after surgery. In another prospective, randomized study of patients undergoing routine wide-awake hand operations under local anesthesia, IVR patients exhibited lower anxiety and more fun during surgery as measured with a Likert scale at several time points [ 12 ]. In addition, these patients also reported greater relaxation throughout the procedure than those not using IVR.…”

“…IVR was first introduced into perioperative practice to reduce anxiety and pain related to general anesthesia and associated preoperative interventions [ [6] , [7] , [8] ]. More recently, distractive IVR use has been expanded to the operative environments whereby surgical procedures can be performed under regional anesthesia with potential benefits of reducing sedation and patient anxiety [ [9] , [10] , [11] , [12] ].…”

“…The typical IVR experience involves patients wearing a small, comfortable specialized headset and headphones that can project an interactive virtual environment with auditory guidance while surgery is performed under regional or spinal anesthesia. IVR has not been thoroughly investigated in orthopedic surgical applications, and early reports have only provided limited insight into indications, applications, and efficacy, particularly related to its effect on postoperative cognitive function [ [10] , [11] , [12] ].…”

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“…during intravenous cannulation of cancer patients (Wong et al, 2020), preparation for knee surgery (Robertson et al, 2017), stay on an intensive care unit (Ong et al, 2020), or a dental extraction procedure (Koticha et al, 2019). Physiological stress indicators are commonly used to compare the effects of the virtual distraction to control groups (Ding et al, 2019;Hoxhallari et al, 2019;Rao et al, 2019).…”

Effects of a simulation-based blended training model on nurses’ treatment decision-related knowledge about oral cancer in Taiwan: a pilot survey

“…Virtual reality (VR) technology can create ideal educational aids that provide consistent, vivid, and real-time interactions and immersive experiences. VR-based training materials are considered to be an effective tool to supplement in-person education and to cover a variety of topics [ 3 ]. In particular, VR materials can increase users’ motivation and engagement, as well as improving their health knowledge [ 4 , 5 ].…”