Effects of immersive virtual reality therapy on intravenous patient-controlled sedation during orthopaedic surgery under regional anesthesia: A randomized controlled trial

• Published in: PloS one Vol. 15; no. 2; p. e0229320
• Main Authors: Huang, Mark Y, Scharf, Simon, Chan, Peter Y
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.02.2020; Public Library of Science (PLoS)
• Subjects: Aged; Analgesia; Analgesia, Patient-Controlled - methods; Analysis; Anesthesia; Anesthesia, Conduction - methods; Anesthetics, Intravenous; Anxiety; Arthroplasty; Arthroplasty (knee); Arthroplasty, Replacement - methods; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Australia; Bias; Biology and Life Sciences; Biomedical materials; Bupivacaine; Clinical trials; Computer and Information Sciences; Computer applications; Conscious Sedation - methods; Engineering and Technology; Female; Headphones; Hill, Victoria; Hip; Hip replacement arthroplasty; Hospitals; Humans; Immersive virtual reality; Intravenous administration; Joint replacement; Joint replacement surgery; Joints (anatomy); Male; Market surveys; Medical personnel; Medicine; Medicine and Health Sciences; Middle Aged; Nature; Orthopedic Procedures - methods; Orthopedic surgery; Orthopedics; Pain; Pain Measurement; Pain perception; Pain, Postoperative - etiology; Patient satisfaction; Patients; Phenols (Class of compounds); Propofol; Propofol - administration & dosage; Randomization; Registration; Side effects; Social Sciences; Studies; Surgery; Surgical implants; Therapy; Time; Total hip arthroplasty; Virtual reality; Virtual Reality Exposure Therapy; Australia; Netherlands; Victoria Australia; California; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0229320

Immersive virtual reality (IVR) is a form of distraction therapy that has shown potential as an analgesia and sedation sparing agent. This study assessed the effect of IVR on the self-administered sedation requirements of patients undergoing joint replacement surgery under regional anesthesia in a single center. This study was a single-center, randomized control trial at St Vincent's Hospital in Melbourne, Australia. Fifty patients undergoing elective total knee and total hip arthroplasty were randomized to IVR and Propofol patient-controlled sedation (PCS) or propofol PCS alone. The primary outcome measure was intra-operative propofol use. Secondary outcomes included pattern of propofol use over time, use of adjunct analgesia, unmet propofol demand, and patient satisfaction survey scores. Of 50 total patients, 25 received IVR in conjunction with PCS, and 25 received PCS alone. All patients received adjunct analgesia from the treating Anesthesiologist. Median propofol use/hour over the entire procedure in the control group was 40 (11.1, 93.9) mg/hour compared with 45 (0, 94.7) mg/hour in the IVR group (p = 0.90). There were no differences in patterns of propofol use over the course of each procedure. Adjusting for various baseline characteristics did not change the results. Postoperative satisfaction scores were equivalent in both groups. The VR intervention was well tolerated by all patients, with no report of major side effects. Key limitations were relatively small sample size, the non-blinded nature of the study, and use of adjunct analgesia. In patients receiving joint replacement surgery under regional anesthesia with PCS, IVR was well tolerated but did not decrease the overall sedation requirement.