Digital Doses: Virtual Reality Use for Perioperative Pain and Anxiety in Patients Undergoing Hand Surgery.

Purpose: Virtual reality (VR) is increasingly recognized as a complementary tool to address pain and anxiety. We conducted a randomized controlled trial to evaluate the effectiveness of VR for the management of pain and anxiety in patients undergoing minor hand surgery. Methods: Patients undergoing outpatient hand surgery were randomized to VR or control groups. In addition to the standard anesthetic protocol, the VR group received a VR experience as part of their preoperative care. Patient anxiety and pain scores were collected using the Numerical Visual Analog Anxiety Scale and Numerical Rating Scale, respectively. In addition, we recorded changes in patient hemodynamics and any additional medication doses required to manage pain or anxiety. Results: Forty-one patients (21 VR and 20 control) were enrolled. There were no differences in reported pain or anxiety scores before, during, or after surgery. There was no difference in vital signs or recovery times. Patients in the VR groups received less additional midazolam (0.4 mg vs 1.2 mg) and fentanyl (10 mcg vs 27.4 mcg) compared with patients in the control group. In a multivariable model, VR use remained the only significant predictor for no required midazolam. Eighty-five percent of patients believed that the use of VR positively impacted their surgical experience. As a result of the VR experience, 78% believed that their anxiety decreased and 61.1% believed that their pain decreased. Conclusions: Although patient pain and anxiety levels between the VR and non-VR groups were similar, the VR group required significantly less midazolam and fentanyl. Moreover, VR use was the only predictor of not requiring midazolam administration during surgery. Patient satisfaction was high with VR usage. VR implementation during minor hand surgery is a viable option to improve patient experience. Type of study/Level of evidence: Therapeutic IIB.