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The Effect of Virtual Reality on Peri-Operative Anxiety during WALANT Hand Surgery: A Prospective Randomized Trial
Kazune Matsuoka, BS
1, Jahan Aslami, BS
2, Alexis Kasper, BS
3, Kimberly Dong, BS
3, Zachary Demetriou, BS
3, Yousef Soliman, BS
3; Asif M. Ilyas, MD, MBA
2,3(1)Philadelphia College of Medicine, Philadelphia, PA, (2)Drexel University College of Medicine, Philadelphia, PA, (3)Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
Introduction: Wide-Awake Local Anesthesia No Tourniquet (WALANT) surgery has been a trending technique in hand surgery. However, there is still a concern about patient anxiety being awake during hand surgery. Virtual Reality (VR) has been introduced as a potential tool to mitigate potential anxiety. A prospective randomized trial was undertaken to better understand the effect of VR during WALANT hand surgery, with the hypothesis that patients using VR would have less anxiety during WALANT hand surgery.
Materials and Methods: After IRB approval, a randomized control study who were scheduled to undergo WALANT hand surgery at a single orthopedic surgery center from November 2023 to January 2024 was conducted. Patients were randomly placed into either the VR experimental group (n=30) or the control group (n=29) through a randomizer generator. The experimental group chose up to three interactive VR videos to watch during their WALANT procedure, while the control group underwent standard operative protocol. Both group's pain levels, anxiety levels, and satisfaction levels were measured pre-, intra-, and post-operatively, along with blood pressure and heart rate. The VR headset provided by "
Wide Awake Virtual Reality" (WAVR), was pre-programmed with various interactive virtual reality videos (Figure 1). The VR headset was placed upon the patient's head, along with noise-canceling headphones, to provide an optimal immersive experience.
Results: Anxiety scores were analyzed using Welch two sample t-tests with a p-value of <0.05 indicating statistical significance. Mean anxiety scores between VR and Control groups before surgery were not statistically significant (p=0.112). Mean anxiety scores between VR and Control groups during (p<0.001, 95% CI [1.74-4.54]) and after (P<0.001, 95% CI [0.922-3.17]) surgery were found to be statistically significant lower in the VR group. Within the Control group, mean anxiety scores compared before surgery vs during surgery (p=0.4253) and before surgery vs after surgery (p=0.1572) were not statistically different. However, within the VR group, mean anxiety scores compared before surgery vs during surgery (p<0.05, 95% CI [.21-2.32]) and before surgery vs after surgery (p<0.001 95% CI [1.08-2.92]) were found to be statistically different.
Conclusions: Anxiety lower during and after surgery in the VR group compared to the Control group. Anxiety was seen to be decreased within the VR group but not within the Control group. The study finds that VR can be used in the perioperative setting to significantly reduce patient anxiety during WALANT hand surgery.
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