With conditions such as carpal tunnel syndrome and osteoarthritis on the rise, U.S. hand surgeons perform more than half a million procedures each year. Patients undergoing hand surgery commonly receive a regional anesthetic to block pain prior to the procedure, plus monitored anesthesia care (MAC) during the operation. MAC typically consists of an IV-administered sedative – such as propofol – to keep patients feeling sleepy and calm during procedures but awake enough to follow instructions as needed. Too much sedation, however, can lead to low blood pressure, upper airway obstruction and potentially serious complications such as stroke, heart attack or respiratory failure. Now, the results of a randomized controlled trial suggest that virtual reality immersion can minimize the need for sedatives during hand surgery without negatively impacting patient satisfaction.  

Physician-scientists at Beth Israel Deaconess Medical Center (BIDMC, Boston, MA, USA) used VR technology software from XRHealth (Brookline, MA, USA) in the clinical trial consisting of 34 patients undergoing hand and wrist surgery. All of the patients were given a peripheral nerve block before surgery. Patients were randomized to intraoperative immersive virtual reality with intravenous anesthesia only given as needed, or to usual care as directed by the anesthesiologist. The VR therapy software provided an immersive, engaging environment that guided patients through relaxation and pain reduction techniques while undergoing the surgery.

The results of the trial showed that the majority of patients (13/17) using the XRHealth VR technology did not need any intravenous sedatives during surgery. A postoperative survey demonstrated similarly low levels of pain and anxiety for patients in both control groups. Other secondary findings demonstrated that patients using the VR technology recovered from anesthesia more quickly and left the recovery room earlier than those in the usual care group. These findings could lead to a discussion in the medical industry about using non-pharmaceutical interventions during surgical procedures that both enhance the patient experience during surgery and provide a better postoperative recovery.

"Anesthesia providers are always trying to balance the primary interests of patient comfort and patient safety. Our results demonstrate that VR may help provide satisfactory control of pain and anxiety for procedures such as upper extremity surgery with regional anesthesia," said senior study author Brian O'Gara, MD MPH, Principal Investigator at Beth Israel Deaconess Medical Center. "This is incredibly valuable in that VR may allow for avoidance of risky sedatives without detracting from the patient experience. If the use of this technique can also aid perioperative efficiency, it has the potential to be a real game-changer for both patients and providers."

"Transporting patients to different treatment rooms in the metaverse while undergoing operations in the real world can provide significant medical breakthroughs in the healthcare industry; managing pain and anxiety in a virtual environment can be a game changer for coping through surgical procedures and will help the patients' body heal faster eliminating the recovery from the anesthesia," added Eran Orr, CEO of XRHealth. 

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