Summary

Immersive virtual reality was associated with improved immediate pain control, decreased use of postoperative opioids, and less anxiety in patients undergoing hip arthroscopy.

Abstract

Background

Immersive virtual reality (iVR) creates a digital, captivating 360-degree environment of visual and auditory stimuli. Initially used for entertainment, a recent trend toward utilizing iVR in the healthcare setting has developed. Innovation from academic medical centers and healthcare startups has shed light on iVR as perioperative therapy for pain management and anxiety. In the ambulatory orthopedic setting, there is a void of literature on iVR. One study found iVR effective in decreasing pain perception in orthopedic trauma patients during external fixator pin removal in the outpatient setting. Another study demonstrated that iVR decreased pain and anxiety following total knee arthroplasty. In tandem, studies have shown a trend toward over prescription of opioids for patients undergoing arthroscopic procedures. The goal of this study was to determine if postoperative iVR affects subjective pain, anxiety, nausea, and opioid consumption in patients undergoing hip arthroscopy.

Methods

We prospectively compared a cohort of hip arthroscopy patients with femoroacetabular impingement (FAI) who receive postoperative iVR therapy in addition to the standard multimodal pain regimen with a matched cohort of patients who received only the standard regimen. The iVR group received a 30-minute session of virtual relaxation and meditation therapy in the ambulatory post-anesthesia care unit (PACU). Both groups received the standard preoperative local anesthetic nerve block and postoperative pain medications as needed. Patient demographics, milligram morphine-equivalents (MMEs) consumed, nausea/vomiting, anxiety scale (1 to 10), and visual analog scale (VAS) pain ratings were collected for both groups.

Results

A total of 32 patients were randomized in this study, 17 in the iVR group and 15 in the control group. The average age in the iVR group was 32 (47.1% female, 52.9% male) and the average age in the control group was 28 (60% female, 40% male). All patients underwent hip arthroscopy with labral repair, femoroplasty and capsular repair. Patients that received iVR had decreased anxiety [3.63 vs. 4.57 (p = 0.30)], slightly decreased sensory and cognitive VAS in PACU [5.31 vs. 4.71 (p = 0.43) and 4.67 vs. 4.86 (p = 0.79), respectively] and decreased opioid consumption [1.68 vs. 5.10 MMEs (p = 0.19)] despite an increased mean VAS [3.71 vs. 3.29 (p = 0.51)] in the first week postoperatively. There was no nausea or difference in eye strain, headaches, or motion sickness reported in either group.

Discussion

iVR was associated with improved immediate pain control, decreased use of postoperative opioids, and less anxiety. iVR served as a useful adjunct for multimodal pain therapy the setting of hip arthroscopy.