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A Randomized Controlled Trial of Virtual Reality in Awake Minor Pediatric Plastic Surgery Procedures
Paul G B Clerc1, Jugpal S Arneja1, Charlotte M Zwimpfer1
1From the Pediatric Research in Emergency Therapeutics Program, Goldman's Pain Laboratory, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Research Institute; Division of Plastic Surgery, British Columbia Children's Hospital and University of British Columbia; Sauder School of Business, University of British Columbia; and Emergency Department, Peace Arch Hospital, Department of Emergency Medicine, University of British Columbia.
Insights
Virtual reality (VR) in pediatric plastic surgery reduced procedure time but did not significantly decrease pain or anxiety compared to standard care. VR was safe, well-liked by younger patients, and surgeons expressed interest in its future use.
Area of Science:
- Medical Technology
- Pediatric Surgery
- Pain Management
Background:
- Virtual reality (VR) is increasingly utilized for pain and anxiety management in various medical settings.
- Its application in pediatric plastic surgery, particularly for awake procedures, warrants investigation to address potential patient discomfort.
Purpose of the Study:
- To evaluate the efficacy of virtual reality as a distraction technique during common awake minor plastic surgery procedures in children.
- To compare VR's impact on pain, anxiety, procedure duration, and patient/surgeon satisfaction against standard-of-care distraction methods.
Main Methods:
- A randomized controlled trial involved children aged 6 to 16 undergoing awake minor plastic surgery.
- Participants were assigned to either virtual reality distraction or standard-of-care distraction.
- Outcomes measured included pain scores (Faces Pain Scale-Revised), anxiety (Venham Situational Anxiety Scale), procedure duration, local anesthetic use, and satisfaction.
Main Results:
- No significant differences in pain or anxiety scores were observed between the virtual reality and standard care groups.
- Procedures utilizing virtual reality were significantly shorter (22 minutes vs. 29 minutes).
- Patient and surgeon satisfaction with pain and anxiety management was similar, though younger children found VR more enjoyable.
Conclusions:
- Virtual reality effectively reduced procedure time in awake pediatric plastic surgery but did not significantly alleviate pain or anxiety compared to standard distraction.
- VR is a safe and well-received adjunct tool that can enhance operational efficiency in pediatric plastic surgery.
- Further consideration of VR as an additional tool for improving surgical workflow is recommended.
Background:
Virtual reality has been used to alleviate pain and anxiety in a variety of medical procedures. The authors sought to explore the effects of virtual reality in common awake minor plastic surgery procedures where children may experience discomfort.
Methods:
A randomized controlled trial compared virtual reality to standard-of-care distraction among children aged 6 to 16 years undergoing awake minor plastic surgery procedures at a quaternary children's hospital. Primary outcome was change in Faces Pain Scale-Revised pain score, and secondary outcomes included change in Venham Situational Anxiety Scale score, procedure duration, administration of local anesthetic, and pain/anxiety management satisfaction.
Results:
Mean pain and anxiety scores were similar in both groups (p = 0.60 and p = 0.18, respectively), and procedure duration was shorter with virtual reality (22 minutes versus 29 minutes; p = 0.002). Duration remained shorter in a linear regression model accounting for procedure type (p = 0.01). Similar proportions of children received additional local anesthetic after the initial dose (virtual reality, n = 6; standard of care, n = 9; p = 0.19) and median pain management satisfaction was similar (virtual reality, 9 of 10; standard of care, 9 of 10; p = 0.41). Median anxiety management satisfaction was similar (virtual reality, 9 of 10; standard of care, 9 of 10; p = 0.05). Younger children reported more "fun" than older children with virtual reality (p = 0.02). Surgeons reported interest "using virtual reality again" in 83 percent of cases.
Conclusions:
The use of virtual reality for awake pediatric plastic surgery reduced procedure time but not pain or anxiety compared to standard of care in children aged 6 to 16 years. Virtual reality was safe and well-liked and should be considered as an additional tool. Increased efficiency may allow more cases to be performed.
Clinical Question/Level Of Evidence:
Therapeutic, II.
