September 23, 2022
Published results showed use of virtual reality immersion during hand surgery may reduce intraoperative propofol dose and post-anesthesia care unit length of stay without negatively impacting patient-reported outcomes.
“With the increase in the amount of time people spend at the keyboard combined with our aging population, there is a projected increased need for common elective hand surgeries,” Brian P. O’Gara, MD, MPH, senior author and anesthesiologist in the department of anesthesia, critical care and pain medicine at Beth Israel Deaconess Medical Center, said in a press release. “Optimizing care for these patients will undoubtedly involve modification to anesthetic practices. Virtual reality’s purported benefit in the management of patients with pain or anxiety is through providing an immersive experience capable of distracting the mind from processing the unpleasantries associated with undergoing surgery.”
O’Gara and colleagues randomly assigned 40 patients undergoing hand surgery to receive either intraoperative virtual reality (VR) in addition to monitored anesthesia care or usual monitored anesthesia care. Researchers noted patients in the VR group intraoperatively viewed programming of their choice through a head-mounted display, and patients in both groups received preoperative regional anesthesia at provider discretion. Researchers considered intraoperative propofol dose per hour as the primary outcome and patient-reported pain and anxiety, overall satisfaction, functional outcome and post-anesthesia care unit (PACU) length of stay as secondary outcomes.
Among the 34 patients who completed the perioperative portion of the trial, results showed patients in the VR group received significantly less propofol per hour vs. the control group. Researchers found no significant differences in patient-reported overall satisfaction between the two groups. Both groups also had no significant differences with regard to PACU pain scores, perioperative opioid analgesic dose or postoperative functional outcome, according to results. Researchers noted patients in the VR group had significantly decreased PACU length of stay.
“Our trial is novel in that it is the first to report a significant reduction in sedative dosing with VR immersion during hand surgery on adults,” O’Gara, who is also an assistant professor in anesthesia at Harvard Medical School, said in the release . “Using VR immersion, the potential harms of unnecessary sedation can be avoided without compromising patient comfort during hand surgery. Furthermore, we saw that the VR group patients were discharged from the PACU 22 minutes earlier than control patients. A reduction in PACU stay could help optimize perioperative efficiency if the VR technique were used more widely.”
Faruki AA, et al. PLoS One. 2022;doi:10.1371/journal.pone.0272030.
VR in the OR: Virtual reality reduced need for sedation during hand surgery. https://www.eurekalert.org/news-releases/965190?. PublishedSep. 21, 2022. Accessed Sept. 21, 2022.