Effects of immersive virtual reality therapy on intravenous patient-controlled sedation during orthopaedic surgery under regional anesthesia: A randomized controlled trial

BackgroundImmersive virtual reality (IVR) is a form of distraction therapy that has shown potential as an analgesia and sedation sparing agent. This study assessed the effect of IVR on the self-administered sedation requirements of patients undergoing joint replacement surgery under regional anesthesia in a single center.Methods and findingsThis study was a single-center, randomized control trial at St Vincent’s Hospital in Melbourne, Australia. Fifty patients undergoing elective total knee and total hip arthroplasty were randomized to IVR and Propofol patient-controlled sedation (PCS) or propofol PCS alone. The primary outcome measure was intra-operative propofol use. Secondary outcomes included pattern of propofol use over time, use of adjunct analgesia, unmet propofol demand, and patient satisfaction survey scores. Of 50 total patients, 25 received IVR in conjunction with PCS, and 25 received PCS alone. All patients received adjunct analgesia from the treating Anesthesiologist. Median propofol use/hour over the entire procedure in the control group was 40 (11.1, 93.9) mg/hour compared with 45 (0, 94.7) mg/hour in the IVR group (p = 0.90). There were no differences in patterns of propofol use over the course of each procedure. Adjusting for various baseline characteristics did not change the results. Postoperative satisfaction scores were equivalent in both groups. The VR intervention was well tolerated by all patients, with no report of major side effects. Key limitations were relatively small sample size, the non-blinded nature of the study, and use of adjunct analgesia.ConclusionsIn patients receiving joint replacement surgery under regional anesthesia with PCS, IVR was well tolerated but did not decrease the overall sedation requirement.背景 沉浸式虚拟现实（Immersive Virtual Reality，IVR）是一种分心疗法，已展现出作为镇痛剂与镇静节约剂的应用潜力。本研究评估了IVR对接受区域麻醉下关节置换手术的患者自行使用镇静药物需求的影响，该项研究为单中心研究。 方法与结果 本研究为澳大利亚墨尔本圣文森特医院开展的单中心随机对照试验。共纳入50名接受择期全膝关节与全髋关节置换术的患者，按随机原则分为两组：IVR联合丙泊酚患者自控镇静（Patient-Controlled Sedation, PCS）组，以及单纯丙泊酚患者自控镇静组。本研究的主要结局指标为术中丙泊酚使用量。次要结局指标包括术中丙泊酚的时间使用模式、辅助镇痛药物使用情况、未满足的丙泊酚用药需求，以及患者满意度调查得分。50名入组患者中，25名接受IVR联合PCS治疗，剩余25名仅接受PCS治疗。所有患者均由主管麻醉医师给予辅助镇痛药物。对照组整个手术过程中每小时丙泊酚使用量的中位数为40（11.1, 93.9）mg/h，IVR组为45（0, 94.7）mg/h（p=0.90）。两组患者术中丙泊酚的使用时间分布模式无显著差异。校正各项基线特征后，研究结果未发生改变。两组患者术后满意度评分相当。所有患者对VR干预的耐受性良好，未报告严重不良反应。本研究的主要局限性包括样本量相对较小、研究未采用盲法，以及使用了辅助镇痛药物。 结论 对于接受区域麻醉下关节置换手术并使用PCS的患者而言，IVR耐受性良好，但未降低整体镇静药物使用需求。