Virtual reality vs. pharmacological premedication in perioperative anxiety management

Position du problème et objectif(s) de l’étude

In adults undergoing an intervention under locoregional anesthesia the incidence of perioperative anxiety can reach up to 77%. Virtual reality has been gradually implemented as a non-pharmacological perioperative anxiety therapy. However, few studies have evaluated the superiority of this technology compared to pharmacological premedication. The aim of this study was to compare the anxiolytic effectiveness of immersive VR distraction with that of hydroxyzine pharmacological premedication in managing perioperative anxiety, postoperative pain, and overall satisfaction in patients undergoing surgery under spinal anesthesia.

Matériel et méthodes

We conducted a prospective, randomized, controlled, bicentric trial. The study received a prior approval from the Institutional Review Board, it included adult patients (18–70 years) classified ASA I–III scheduled for elective visceral, orthopedic, or urologic surgery under spinal anesthesia. Exclusion criteria comprised patient refusal, epilepsy, cognitive, psychiatric, visual or auditory impairments, substance use, emergency surgery, prone/lateral positioning, or contraindications to local anesthetics, benzodiazepines,hydroxyzine or VR use. Patients were randomized into two equal groups (n=45); group VR (received intraoperative distraction via a virtual reality headset) and group H (received standard premedication with oral hydroxyzine). The anesthetic protocol was standardized across both groups. The primary outcome was perioperative anxiety, assessed using a Visual Analog Scale (VAS) immediately postoperatively. Secondary outcomes included pain scores, hemodynamic and respiratory parameters (systolic blood pressure, heart rate, respiratory rate, and SpO₂), sedative use (midazolam/propofol), satisfaction levels of both patients and healthcare staff (nurse anesthetists and surgeons) involved in the procedure and incidence of adverse effects.

Résultats & Discussion

A total of 90 patients were included (45 per group). Baseline characteristics, including the Amsterdam Preoperative Anxiety and Information Scale (APAIS) scores and preoperative anxiety levels, were comparable between groups. Postoperative anxiety (VAS) was significantly lower in the VR group (median [IQR]: 0 [0–1]) compared to the H group (3 [2–4]; p < 0.001). The VR group also reported lower pain scores (p < 0.05) and required less intraoperative midazolam (p < 0.05). Hemodynamic parameters were more stable in the VR group (p < 0.05), and both patient and healthcare provider satisfaction were significantly higher (p < 0.05). The incidence of adverse events was similar between groups.

Conclusion

This study demonstrates that Virtual reality significantly reduces perioperative anxiety and pain compared to hydroxyzine, while also improving hemodynamic stability and satisfaction for both patients and providers. Safe and well-tolerated, it represents a promising non-pharmacological alternative in perioperative care. Further studies are needed to confirm its broader applicability.

Auteurs

Farah GUITOUNI, Samia ARFAOUI, Ahlem BATTIKH, Rihem KOUSRI, Hazem JAOUA, Kamel BEN FADHEL - (1)Hôpital Habib Thameur, Tunis, Tunisie

Orateur(s)

Farah GUITOUNI (Tunis)