I. J. Behr1, E. Hoxhallari1, J. Clarkson1 1Michigan State University,Surgery,Lansing, MI, USA
Introduction: While technology has the power to change medical practice, it can sometimes take decades for advances to become adopted. At Michigan State University (MSU) we offer Wide Awake Local Anesthetic Surgery No Tourniquet (WALANT) to our hand surgery patients using virtual reality (VR) technology during procedures. We hypothesized the patient experience might be improved by the introduction of VR.
Methods: All patients undergoing routine WALANT hand surgeries in an office procedure room at MSU Department of Surgery were invited to participate. Data collection took place over a 6-month period.
Unlabelled Envelopes containing either VR or Non-VR were given to patients so that single blinded randomization was achieved; Those who received VR during injection and surgery (VR) and those who did not (Non-VR). A Galaxy S7 phone and a Samsung Gear VR headset with headphones was used.
Phase 1: Tumescent local anesthesia
All patients received an injection of local anesthetic. For the VR patients, this was performed while watching a specifically selected video in which the injection was timed to coincide with a moment of catharsis in the VR experience.
Phase 2: Surgical procedure
During the procedure, VR patients were provided with freely available 360 YouTube materials.
Prospective data collection:
Data was collected prospectively at multiple time points during the injection and procedure phases. In addition, there was a postoperative questionnaire completed by all patients.
Prospective physical observations, including pulse and blood pressure, were recorded. Anxiety, fun, and pain were assessed with a Likert type scale rating each 0-10 points. Follow up questions were administered after the procedure to the VR group. All patients were asked to rate how much they enjoyed their surgical experience on a 10-point Likert type scale.
Results:
There were no significant differences between the VR and Non-VR group for either heart rate or blood pressure (p= 0.0072).
Analysis revealed a highly significant difference between the anxiety scores of VR versus Non-VR patients, with anxiety reduced for the VR group (p=0.0003).
Using a 10-point Likert type scale all patients were asked how much they enjoyed their experience with the VR group reporting significantly higher enjoyment (P= 0.0001).
Conclusion:This study demonstrates readily available VR hardware and software can be utilized to provide a passive and immersive experience that reduces patient anxiety during both the injection phase of tumescent local anesthetic and during the surgical procedure. Patients that utilized VR also reported higher levels of joy during the injection and procedure than those who did not. A post procedural questionnaire also revealed the VR group reported a significantly more enjoyable surgical experience than the Non-VR group.