Abstract

BackgroundAdvancements in virtual reality (VR) technology have resulted in its expansion into health care. Preliminary studies have found VR to be effective as an adjunct to anesthesia to reduce pain and anxiety for patients during upper gastrointestinal endoscopies, dental procedures and joint arthroplasties. Current standard care practice for upper extremity surgery includes a combination of regional anesthesia and intraoperative propofol sedation. Commonly, patients receive deep propofol sedation during these cases, leading to potentially avoidable risks of over-sedation, hypotension, upper airway obstruction, and apnea. The objective of this study is to evaluate the effectiveness of VR technology to promote relaxation for patients undergoing upper extremity surgery, thereby reducing intraoperative anesthetic requirements and improving the perioperative patient experience.MethodsIn this single-center, randomized controlled trial, 40 adult patients undergoing upper extremity orthopedic surgery will be randomly allocated to either intraoperative VR immersion or usual care. VR immersion is designed to provide patients with a relaxing virtual environment to alleviate intraoperative anxiety. All patients receive a peripheral nerve block prior to surgery. Patients in the intervention group will select videos or immersive environments which will be played in the VR headset during surgery. An anesthesia provider will perform their usual clinical responsibilities intraoperatively and can administer anesthetic medications if and when clinically necessary. Patients in the control arm will undergo perioperative anesthesia according to standard care practice. The primary outcome is the difference in intraoperative propofol dose between the groups. Secondary outcomes include postoperative analgesia requirements and pain scores, length of stay in the postanesthesia care unit, overall patient satisfaction and postoperative functional outcomes.DiscussionIt is unknown whether the use of VR during upper extremity surgery can reduce intraoperative anesthetic requirements, reduce perioperative complications, or improve the postoperative patient experience. A positive result from this clinical trial would add to the growing body of evidence that demonstrates the effectiveness of VR as an adjunct to anesthesia in reducing intraoperative pain and anxiety for multiple types of procedure. This could lead to a change in practice, with the introduction of a nonpharmacologic intervention potentially reducing the burden of over-sedation while still providing a satisfactory perioperative experience.Trial registrationClinicalTrials.gov, NCT03614325. Registered on 9 July 2018.

Highlights

  • Advancements in virtual reality (VR) technology have resulted in its expansion into health care

  • Statistical analysis Sample size calculation Based on preliminary data from a related study evaluating the use of VR immersion for major joint surgery, we anticipate that we may be able to achieve a 30% reduction in intraoperative propofol dose between groups [15]

  • This study will be the first to evaluate the potential for VR technology to reduce intraoperative propofol requirements for patients undergoing upper extremity surgery

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Summary

Introduction

Advancements in virtual reality (VR) technology have resulted in its expansion into health care. VR has been found to be safe and effective as an adjunct to standard sedative and analgesic protocols to reduce pain and anxiety for patients during upper gastrointestinal endoscopies, dental procedures, dressing changes for burns, and during the first stage of labor [3,4,5,6] To date, it is unknown whether the use of VR during upper extremity surgery as an adjunct to standard anesthetic practice can reduce intraoperative anesthetic requirements and improve the perioperative patient experience. It is common for patients to receive doses of intravenous sedatives such as propofol that may be out of proportion to their requirements for anxiolysis, potentially increasing the risk of over-sedation, hypotension, upper airway obstruction, apnea and postoperative delirium [7,8,9] Such avoidable risks are common with excessive sedation and can result in serious morbidity. An intervention that could reduce intraoperative sedative requirements could prove to be valuable in reducing the risk of postoperative adverse events after upper extremity surgery

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