Utility of virtual sedation in subcutaneous implantable access port placement: A randomized controlled trial

Virtual reality (VR) is an active distraction method that serves as a non-pharmacological adjunct treatment for pain and anxiety. It offers the potential to be integrated into a multimodal clinical approach. The implantation of a subcutaneous implantable access port (PAC) is a painful procedure for which there is no established sedation protocol. The objective of this study was to evaluate the level of anxiety in patients who underwent PAC implantation outside of the operating room.

A prospective, monocentric, randomized, controlled interventional study was conducted, involving 80 patients, with 40 in the VR group and 40 in the control group. The primary objective of our study was to measure postoperative anxiety levels using the State-Trait Anxiety Inventory (STAI). Secondary objectives included the assessment of pain using the Visual Analog Scale (VAS), patient satisfaction measured by the Net Promoter Score (NPS), and midazolam consumption.

Regarding our primary objective, we observed a reduction in postoperative state anxiety in the VR group, decreasing from 38.8 to 30.30 (p = 0.004). However, there was no significant difference between the two groups, with the mean postoperative STAI value being 30.60 for the VR group and 32.65 for the control group (p = 0.37). We also noted a non-significant reduction in the NPS score in the VR group compared to the control group. Conversely, midazolam consumption was significantly reduced, with a median of 1.65 mg in the control group and 0.325 mg in the VR group (p < 0.01).

In conclusion, our results suggest that virtual reality may serve as a non-pharmacological alternative to reduce anxiety during PAC implantation, decrease sedation requirements, and maintain patient satisfaction regarding the quality of care.