Effects of Immersive Virtual Reality on Patient Anxiety During Surgery Under Regional Anesthesia: A Randomized Clinical Trial

Abstract

Background: Surgery and anesthesia are associated with increased patient anxiety. Perioperative anxiety is a common problem in regional anesthesia procedures and has an extensive impact. Immersive virtual reality (IVR) is a potential non-pharmacological distraction method to reduce anxiety. Immersive virtual reality creates a virtual environment that allows patients to interact and immerse in the virtual world, reducing patient anxiety. Objectives: This study aimed to examine the effect of IVR on the anxiety of patients undergoing regional anesthetic surgery. Methods: A total of 30 participants referred to Dr. Kariadi General Hospital (Indonesia) from October 2021 to December 2021 were enrolled in this randomized, single-blind clinical trial. The patients were divided into virtual reality (VR) and control groups (n = 15 in each group). The control group received midazolam (0.02 mg/kg) as premedication. The VR group received an IVR intervention without premedication. The data of anxiety scores were assessed using the Spielberger state-trait anxiety inventory 6 (STAI-6). This study also collected vital signs, side effects, and patient and surgeon satisfaction level data. Results: The average anxiety level during surgery in the operating room decreased in both groups (P < 0.05); the VR group had a lower score (P = 0.04). The anxiety level was significantly reduced before and during surgery in the VR group than in the control group. The patient satisfaction level was also significantly higher in the VR group than in the control group (P = 0.024). Both groups had no significant difference in monitored vital signs, side effects, and surgeon satisfaction. Conclusions: The IVR intervention could reduce anxiety in patients undergoing surgery under regional anesthesia and improve patient satisfaction.

Using Immersive Virtual Reality Distraction to Reduce Fear and Anxiety before Surgery

“…The current study introduced a nonpharmacological approach, supported by data showing reduced fear and anxiety levels. Although one previous study using noninteractive 360 videos did not reduce pre-op anxiety [31], in the current study, interacting with a computer-generated immersive virtual reality world successfully reduced the fear and anxiety of a female patient while she waited to go into the operating room to have gallbladder surgery. The patient reported having a strong illusion of presence in VR and the illusion of "being there" in the 3D computer-generated world.…”

“…Nonpharmacologic techniques using distraction are being applied during a growing number of medical procedures to provide anxiolysis with the goal of reducing or eliminating the need for sedative administration [11,12]. Immersive virtual reality (VR) is emerging as a sophisticated and effective non-drug technique for anxiety and pain reduction [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], e.g., during venipuncture [29,30] and even during surgery [31]. fMRI studies show that VR reduces pain-related brain activity, and the amount of pain reduction during VR is comparable to a moderate dose of opioids in analgesic effectiveness [32][33][34].…”

“…Patients typically remain conscious during surgery, making regional anesthesia an excellent procedure for adding VR distraction. A recent study compared the effects of premedication with virtual reality distraction vs. midazolam in patients undergoing surgery under combined spinal epidural (CSE) regional anesthesia [31]. The results showed a significantly lower anxiety score in the VR group than in the control group during surgery.…”