The Impact of Virtual Reality on the Patients and Providers Experience in Wide-Awake, Local-Only Hand Surgery

McCullough, Meghan; Osborne, Thomas F.; Rawlins, Caitlin; Reitz, Robert J.; Fox, Paige M.; Curtin, Catherine

doi:10.1016/j.jhsg.2023.01.014

Cited by 5 publications

(2 citation statements)

References 18 publications

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“…There is evidence supporting the use of VRD to reduce anxiety, pain and discomfort in hand surgery and dental and gynaecological procedures, performed under local anaesthesia. [27][28][29] The VR InCard trial can provide valuable information on the feasibility of VR therapy in the catheterisation room. If VR is feasible and results in decreased anxiety, this is a valuable non-pharmacological tool for patients.…”

Section: Discussionmentioning

confidence: 99%

Virtual reality to reduce periprocedural anxiety during invasive coronary angiography: rationale and design of the VR InCard trial

Breunissen,

Groenveld,

Garms

et al. 2024

Open Heart

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IntroductionPatients undergoing invasive coronary angiography (ICA) experience anxiety due to various reasons. Procedural anxiety can lead to physiological and psychological complications, compromising patient comfort and overall procedural outcomes. Benzodiazepines are commonly used to reduce periprocedural anxiety, although the effect is modest. Virtual reality (VR) is a promising non-pharmacological intervention to reduce anxiety in patients undergoing ICA.Methods and analysisA single-centre open-label randomised controlled trial is conducted assessing the effectiveness of add-on VR therapy on anxiety in 100 patients undergoing ICA and experiencing anxiety in a periprocedural setting. The primary outcome is the Numeric Rating Scale (NRS) anxiety score measured just before obtaining arterial access. Secondary outcomes include postarterial puncture and postprocedural anxiety, patient-reported outcome measures (PROMs) of anxiety and physiological measurements associated with anxiety. The NRS anxiety level and physiological measurements are assessed five times during the procedure. The PROM State-Trait Anxiety Inventory and Perceived Stress Scale are completed preprocedure, and the PROM STAI and the Igroup Presence Questionnaire are performed postprocedure.Ethics and disseminationThe protocol of this study has been approved by the Research Ethics Committee of the Radboud University Medical Centre, the Netherlands (CMO Arnhem-Nijmegen, 2023–16586). Informed consent is obtained from all patients. The trial is conducted according to the principles of the Helsinki Declaration and in accordance with Dutch guidelines, regulations, and acts (Medical Research involving Human Subjects Act, WMO).Registration detailsTrial registration number:NCT06215456.

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Section: Discussionmentioning

confidence: 99%

Virtual reality to reduce periprocedural anxiety during invasive coronary angiography: rationale and design of the VR InCard trial

Breunissen,

Groenveld,

Garms

et al. 2024

Open Heart

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“…Most wide-awake patients welcome the opportunity to have a dialog with their surgeon intraoperatively, and many hand surgeons effectively use the operative time to describe surgical findings, demonstrate improved range of motion, or provide postoperative instructions to their patients 75 . On the other hand, patients who are apprehensive about wide-awake anesthesia may experience less anxiety by listening to music through headphones or by using virtual reality distractions during the procedure 76-78 . Patients still anxious after preoperative reassurance about WALANT are usually better served by choosing an alternative anesthesia method.…”

Section: Potential Disadvantages Of Walantmentioning

confidence: 99%

Adoption of the Wide-Awake Local Anesthesia No Tourniquet Technique in Hand Surgery

2023

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» Wide-awake local anesthesia no tourniquet (WALANT) technique featuring tumescent infiltration of lidocaine with epinephrine at the operative site has broad application in hand surgery including both soft-tissue and bone procedures.» The advantages of wide-awake anesthesia include high patient satisfaction, preserved intraoperative finger and wrist motion, cost-effectiveness, improved operating room efficiency, fewer opioids during recovery, and improved access to hand surgery, which may be performed in an office-based setting without the need for anesthesia personnel.» In properly selected patients, use of lidocaine with epinephrine in the hand and fingers is safe. Rare postprocedure digital ischemia may be effectively treated with phentolamine rescue.» Barriers to adopting wide-awake anesthesia may be overcome by educating resistant stakeholders, including hospital administrators, nurse leaders, and anesthesia colleagues, about the advantages of the WALANT method.» The risk of postoperative complications after hand procedures may be mitigated by using the wide-awake technique instead of regional anesthesia with sedation or general anesthesia.

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The wide-awake local anesthesia no tourniquet (WALANT) technique in thumb injuries: a systematic review

do Rosario Saraiva,

Vázquez,

Ortiz-Huerta

et al. 2024

Eur J Trauma Emerg Surg

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Human hands have a complex anatomical structure. The thumb, being an integral part of the hand, has an essential function in gripping. In this sense, thumb fractures account for 4% of all hand fractures (it may occur in association with fractures of the trapezium). The majority of hand fractures should be treated non-surgically and surgeons must avoid unnecessary surgery. Historically, hand surgery has used a combination of local/regional/general anaesthesia and a tourniquet. This study aims to carry out a systematic review to determine whether the WALANT technique is an advantageous alternative to conventional anaesthesia for surgical procedures on thumb injuries, in terms of patient function and pain. Method: We conducted a search in the following databases: Pubmed/Medline, EBSCOhost, Web of Science, Scopus, ScienceDirect and Google Scholar, using the equation "WALANT" OR "Wide Awake Local Anesthesia No Tourniquet" AND "thumb pathology". Results: In five of the 584 articles included, two studied trapeziometacarpal osteoarthritis, one De Quervain's disease and the remaining two flexor injuries. WALANT showed good results in active movements, but with similar levels of pain between anaesthetics. Patients were more anxious during general anaesthesia, plus the fact that they were fasting and suspending medication. Conclusion: WALANT is a convenient and favourable option in several studies. It has been demonstrated the benefits in terms of return to function and pain.

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The Impact of Virtual Reality on the Patients and Providers Experience in Wide-Awake, Local-Only Hand Surgery

Cited by 5 publications

References 18 publications

Virtual reality to reduce periprocedural anxiety during invasive coronary angiography: rationale and design of the VR InCard trial

Virtual reality to reduce periprocedural anxiety during invasive coronary angiography: rationale and design of the VR InCard trial

Adoption of the Wide-Awake Local Anesthesia No Tourniquet Technique in Hand Surgery

The wide-awake local anesthesia no tourniquet (WALANT) technique in thumb injuries: a systematic review

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