Virtual reality and perioperative anxiety: a randomized controlled trial

Preoperative anxiety is a feeling of insecurity, physical and psychological discomfort that arises from the prospect of undergoing surgery. Managing anxiety is a therapeutic cornerstone in anesthetic care. Virtual reality has shown a significant effect on managing anxiety and pain by leveraging the principle of distraction, hypnosis, or a combination of distraction and relaxation. We aim to study the impact of virtual reality on perioperative anxiety during surgeries performed under regional anesthesia. This was a monocentric, prospective, randomized study conducted over a three-month period from March 2023 to May 2023 in the anesthesia and resuscitation department of Taher Sfar Hospital in Mahdia. A total of 72 patients scheduled for orthopedic surgeries were included. Patients were randomized to be allocated to: VR+ group (n = 36), who experienced virtual reality during the operation, or the VR- group (n = 36), who did not experience virtual reality. The consumption of anxiolytics (Midazolam) was evaluated intraoperatively along with perioperative anxiety levels (ICD-11 code MB24.6). Anxiety levels were assessed using the STAI-6, and LIKERT scales. Patient satisfaction was measured using the LIKERT scale. Data from 68 patients were analyzed, with 34 patients in each group. Our study showed that there were no significant differences in preoperative anxiety levels between the groups (average STAI-6 score: VR- = 43.2 vs. VR+ = 44.8). Virtual reality reduced the frequency of anxiolytic use intraoperatively: 61.7% in the VR- group vs. 5.8% in the VR+ group (p < 0.001), as well as the quantity used. Postoperative anxiety reduction was comparable between groups. All patients included in the study exhibited very low anxiety levels according to the STAI-6 score, taking preoperative anxiety levels into account. Virtual reality can be considered an effective method for managing perioperative anxiety during surgeries under regional anesthesia and helps prevent postoperative complications.