Virtual Reality for PEripheral Regional Anesthesia (VR-PERLA Study)

Abstract

When used as an add-on to regional anesthesia, virtual reality (VR) has been reported to provide anxiety-reducing benefits and sedation-sparing effects. However, its impact on patient satisfaction is still a matter of controversy. We investigated the feasibility and benefits of implementing intraoperative VR distraction in a French University Hospital (Hôpital Saint-Antoine, AP-HP). This monocentric observational before-after study included 100 patients who underwent ambulatory upper limb surgery under peripheral nerve block in January 2019, 50 before and 50 after implementation of an intraoperative VR distraction protocol. Primary outcome was patient self-rated satisfaction score evaluated right after surgery. Secondary outcomes included 2-month patient-reported satisfaction score, perioperative self-rated anxiety and intraoperative hemodynamic changes. Compared to former standard care, VR distraction was associated with significantly higher postoperative satisfaction scores (10 [IQR 9; 10] vs. 9 [8; 10], p < 0.001) still reported two months after surgery (10 [10;10] vs. 10 [8.5;10], p = 0.06). Patient median intraoperative anxiety score was lower in the VR group, compared to Standard Care group (0 [0; 2] vs. 3 [0.25; 7], p < 0.001), and occurrence of intraoperative hemodynamic changes was also lessened in the VR group (2% vs. 16%, 0R = 0.11[95% CI 0.002-0.87], p = 0.031). The present findings suggest that VR distraction program in the operating room could effectively improve patient satisfaction with anxiety-reduction and hemodynamic benefits.

Keywords: ambulatory surgery; anesthesia; anxiety; regional anesthesia; satisfaction; virtual reality.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1

Environment screenshots (a) Tropical beach; (b) Sunset Beach; (c) Mountain sunrise; (d) Forest nap.

Figure A2

Postoperative satisfaction questionnaire.

Figure A3

Virtual Reality Headset Tracking Sheet (1/2).

Figure A4

Virtual Reality Headset Tracking Sheet (2/2).

Figure 1

(a) Virtual reality helmet set up after installation in the operating room; (b) intraoperative virtual reality session.

Figure 2

Boxplot graphical representations of the immediate postoperative and 2-month postoperative 10-points satisfaction scores of patients operated before (Standard Care group, dark-grey dots boxplot) and after (Virtual Reality group, light-grey triangles boxplot) virtual reality became available in the department. The upper edge of the box represents the 75th percentile and the lower edge represents the 25th percentile. The vertical length of the box represents the interquartile interval and the central horizontal line represents the median. The upper moustache extends from the upper edge to the highest value at 1.5 times the interquartile space. The lower moustache extends from the lower edge to the lowest value at 1.5 times the interquartile space each dot or triangle represents a patient. Some jittering was added to prevent the overplotting of dots. Please note that in the VR study-group, at month 2, the representation of the boxplot merges with its median.

Figure 3

Boxplot graphical representation of perioperative (pre—in dark-grey plots and intraoperative—in light-grey triangles) anxiety scores of patients operated before (Standard Care group) and after (Virtual Reality group) virtual reality became available in the department. The upper edge of the box represents the 75th percentile and the lower edge represents the 25th percentile. The vertical length of the box represents the interquartile interval and the central horizontal line represents the median. The upper moustache extends from the upper edge to the highest value at 1.5 times the interquartile space. The lower moustache extends from the lower edge to the lowest value at 1.5 times the interquartile space. Each dot or triangle represents a patient. Some jittering was added to prevent the overplotting of dots.