Virtual Reality for the Management of Postoperative Pain and Anxiety in Children and Adolescents Undergoing Nuss Repair of Pectus Excavatum: Randomized Controlled Trial.

Background: Virtual reality (VR) is a novel technology with implications for pain and sensory processing. VR may serve as a novel, scalable method to deliver clinically validated therapy for pain management as an alternative or adjunct to opioids for acute pain. Given that psychological factors and pain perception are both components of postoperative pain, it may also be beneficial to incorporate modalities that decrease anxiety, such as active relaxation and guided meditation with VR. Unfortunately, these therapies are not widely available due to multiple barriers. VR has the potential to deliver pain-reducing, psychologically based therapy to children, thereby enhancing multimodal analgesia and potentially decreasing opioid use. This study investigates the role of VR in reducing pain and anxiety after surgery. Given the substantial risks associated with opioid use, particularly in younger populations, alternative pain management strategies are crucial. Objective: The primary aim of this study was to evaluate the efficacy of VR as a nonpharmacological intervention for managing postoperative pain intensity, pain unpleasantness, anxiety, and opioid use in children and adolescents undergoing Nuss repair of pectus excavatum. Methods: A single-center, prospective, randomized, controlled trial was conducted at a tertiary care children's hospital and research center. Ninety children and adolescents (8-18 y) undergoing the Nuss procedure were randomized to guided relaxation or mindfulness VR (n=30) and distraction-based gaming VR (n=30), combined to form the VR group (n=60), and a control group using a passive 360° video (n=30). Patients received a 10-minute session on postoperative days 1 and 2. Pain intensity, pain unpleasantness, and anxiety were evaluated before and 0-, 15-, and 30-minute post-session. In-hospital pain scores, anxiety scores, and opioid use were collected. Results: Children and adolescents who participated in VR reported a significantly greater decrease in pain intensity from baseline (0.41, SE 0.23) compared with those in the 360° video group at 30 minutes (P=.04) before multiplicity adjustment but not after multiplicity adjustment. There were no significant differences in pain scores or opioid use between the VR and control groups on postoperative day 1 or 2, nor were there changes in pain unpleasantness or anxiety at any time after the intervention. Conclusions: Daily, 10-minute VR sessions provided some trends toward transient analgesic and anxiolytic effects, albeit none that were statistically significant. VR did not significantly decrease overall pain scores or opioid usage, possibly due to the limited intervention duration and high standardized opioid use. Future studies should investigate extended and more frequent VR sessions and the integration of VR with other therapeutic modalities.