Virtual reality compared to nitrous oxide for labor analgesia: a feasibility pilot, prospective, randomized,...

Virtual reality (VR) platforms have emerged as a non-pharmacologic labor analgesic. We hypothesized that VR would be non-inferior to nitrous oxide (N₂O) for satisfaction with labor pain relief. The primary aim compared efficacy of VR to N₂O for satisfaction with pain relief during labor.

We conducted a Institutional Review Board approved, prospective, randomized, crossover, non-inferiority study comparing VR to N₂O. The primary outcome was satisfaction with pain relief (verbal numerical rating scale 0--10) post-intervention at 30 minutes. Secondary outcomes were satisfaction with pain relief at 15 min (0-10), change in pain (0-10), anxiety (0-10), ability to cope with pain (0-10), incidence of side effects and therapeutic modality preference. Parturients received 30 minutes of VR and then 30 min of N₂O, with a 5-minute washout between interventions to reduce carryover. The order of VR and N₂O was randomized. A < 2/10 difference between groups was selected as the non-inferiority margin.

18 of 20 patients completed the study with 9 in each group. The VR intervention was non-inferior to N₂O for satisfaction with pain relief, change in pain, anxiety, and coping. At 15- and 30-min time intervals, respectively, satisfaction with pain relief difference between VR and N₂O was non-inferior [-0.24, 90 % CI (-1.53, 1.06) and 0.65, 90 % CI (-0.66, 1.95)].

Data from this pilot study suggest that VR is a promising non-pharmacological analgesic option that is non-inferior to N₂O for labor pain management. Future larger, well-powered studies are needed to confirm the results of this study.