Abstract
BackgroundImmersive virtual reality (IVR) is a form of distraction therapy that has shown potential as an analgesia and sedation sparing agent. This study assessed the effect of IVR on the self-administered sedation requirements of patients undergoing joint replacement surgery under regional anesthesia in a single center.Methods and findingsThis study was a single-center, randomized control trial at St Vincent’s Hospital in Melbourne, Australia. Fifty patients undergoing elective total knee and total hip arthroplasty were randomized to IVR and Propofol patient-controlled sedation (PCS) or propofol PCS alone. The primary outcome measure was intra-operative propofol use. Secondary outcomes included pattern of propofol use over time, use of adjunct analgesia, unmet propofol demand, and patient satisfaction survey scores. Of 50 total patients, 25 received IVR in conjunction with PCS, and 25 received PCS alone. All patients received adjunct analgesia from the treating Anesthesiologist. Median propofol use/hour over the entire procedure in the control group was 40 (11.1, 93.9) mg/hour compared with 45 (0, 94.7) mg/hour in the IVR group (p = 0.90). There were no differences in patterns of propofol use over the course of each procedure. Adjusting for various baseline characteristics did not change the results. Postoperative satisfaction scores were equivalent in both groups. The VR intervention was well tolerated by all patients, with no report of major side effects. Key limitations were relatively small sample size, the non-blinded nature of the study, and use of adjunct analgesia.ConclusionsIn patients receiving joint replacement surgery under regional anesthesia with PCS, IVR was well tolerated but did not decrease the overall sedation requirement.
Highlights
Immersive virtual reality (IVR) is a form of distraction therapy, used as early as 2003 as an analgesia and sedation sparing agent [1], and has shown potential in the management of wound care, physical therapy, and anxiety-provoking procedures [2,3,4,5]
Fifty patients undergoing elective total knee and total hip arthroplasty were randomized to IVR and Propofol patient-controlled sedation (PCS) or propofol PCS alone
This study demonstrated a statistically significant reduction in sedation requirements, with average propofol use of 155mg/hour and average total use of 260mg in non-IVR patients, compared with average use of 63 mg/hr and average total use of 102mg in IVR patients [6]
Summary
Immersive virtual reality (IVR) is a form of distraction therapy, used as early as 2003 as an analgesia and sedation sparing agent [1], and has shown potential in the management of wound care, physical therapy, and anxiety-provoking procedures [2,3,4,5]. This study demonstrated a statistically significant reduction in sedation requirements, with average propofol use of 155mg/hour and average total use of 260mg in non-IVR patients, compared with average use of 63 mg/hr and average total use of 102mg in IVR patients [6]. These findings were limited by small numbers of participants, as well as the absence of blinding, which allowed selection bias and created the potential for anesthesiologists to unwittingly administer less propofol to the IVR group. This study assessed the effect of IVR on the selfadministered sedation requirements of patients undergoing joint replacement surgery under regional anesthesia in a single center
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