Intraoperative virtual reality for older patients undergoing total knee arthroplasty: study protocol for a randomized...

Area of Science:

• Anesthesiology
• Surgical Innovation
• Geriatric Care

Background:

• Oversedation is a growing concern in the perioperative care of aging surgical patients.
• Intraoperative virtual reality (VR) presents a potential method to decrease sedative requirements.
• This study investigates VR's impact on sedation and outcomes in older adults undergoing total knee arthroplasty (TKA).

Purpose of the Study:

• To evaluate the efficacy of immersive VR in reducing propofol requirements during TKA.
• To assess the impact of VR on patient satisfaction and postoperative opioid consumption.
• To compare VR immersion with music and sham VR controls in TKA patients.

Main Methods:

• A single-center, randomized clinical trial involving patients over 60 undergoing TKA.
• Participants were randomized into three groups: VR immersion, music, or sham VR (usual care).
• All patients received regional block and spinal anesthesia; sedation was managed with patient-controlled sedation (PCS) or monitored anesthesia care (MAC) with propofol.

Main Results:

• The primary outcome was the intraoperative dose of propofol (mg kg^-1 min^-1).
• Secondary outcomes included patient satisfaction, PACU length of stay, pain scores, analgesic requirements, functional outcomes, delirium, and neurocognition.
• Statistical significance was determined by a two-sided p-value < 0.05 using IBM SPSS Statistics Version 25.

Conclusions:

• Immersive VR may serve as a non-pharmacological adjunct to anesthesia during TKA, potentially reducing sedative needs.
• This approach could positively influence perioperative complications and length of stay for elderly patients.
• VR use during TKA demonstrated the potential to maintain a high level of patient satisfaction while minimizing sedation.