The use of VR avoids potential harm in hand surgery, new study finds

It also reduced risks of over-sedation while allowing earlier discharges.
Ameya Paleja
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Surreal image of a woman immersed in liquid with VR glasses on

Woman In VR Glasses 

A randomized control trial conducted by the researchers at the Beth Israel Deaconess Medical Center (BIDMC), a teaching hospital of Harvard Medical School showed that virtual reality (VR) immersion during a hand surgery reduced the need for sedation, a press release said.

More than half a million hand surgeries are conducted in the U.S. every year. During each of these surgeries, the patient receives a regional anesthetic to block the pain prior to the procedure while also receiving monitored anesthesia care (MAC) while the surgery is conducted.

Propofol is the sedative that is preferred for MAC since it can be administered intravenously (IV) and keeps patients sleepy and calm during the procedure but awake enough to follow instructions, when required. Propofol comes with its risks such as low blood pressure and upper airway obstruction, which can also lead to events like stroke, heart attack, or respiratory failure, in case of oversedation.

Can Virtual Reality be used instead?

Between December 2018 and August 2019, a team of researchers at BIDMC randomized 34 patients undergoing hand surgeries at its facility to receive MAC alone or a VR immersion in addition to MAC.

Patients who received the VR immersion wore headsets and noise cancellation headphones during their procedure. They were also provided options from a range of 360-degree VR environments such as meadow, forest, or mountain top that would help them calm down and relax during the procedure.

For both, the group, supplemental anesthetics, and pain medications were administered if the patient requested them or if the anesthesia provider thought it was necessary as per their clinical judgment. The study's investigators were neither assigned to be anesthesia providers nor were present in the operating room when the control group subjects were being operated upon, the press release clarified.

How much difference did VR make?

The researchers found that the VR group received significantly less propofol during their procedures. A median of 260 mg less propofol was used per case than patients in the control group.

Only four of the 17 patients who received VR immersion used any propofol at all during their procedure while every single patient in the control group did. Contrastingly, more patients in the VR immersion group needed supplemental local anesthesia from the surgeon when compared to the control group, suggesting that the preoperative nerve block is critical to the VR immersion intervention.

The researchers also carried out questionnaire-based surveys on all the study's participants while they were in the post-anesthesia care unit (PACU) after their surgery. Both groups of patients reported satisfaction with their procedures while confirming that they were relaxed and their pain-managed well during the surgery.

The pain scores in the PACU as well as peri-operative opioid doses between the groups were not significantly different. However, the VR immersion group participants were discharged from the PACU on an average 22 minutes earlier than those in the control group.

“With the increase in the amount of time people spend at the keyboard combined with our aging population, there is a projected increased need for common elective hand surgeries,” said Brian P. O’Gara, an anesthesiologist at BIDMC in the press release. "Using VR immersion, the potential harms of unnecessary sedation can be avoided without compromising patient comfort during hand surgery."

The researcher findings were published today in the jorunal PLoS One.

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