As an anesthesiologist, Adeel Faruki, MD, MBA, works with patients to manage not only pain, but also anxiety. This may be a particular concern for patients receiving nerve block, rather than sedation or general anesthesia, for upper extremity procedures such as hand surgery.
“If a nerve block is performed that blocks the nerves innervating the area a surgeon is working on, what we typically manage intraoperatively is anxiety and hemodynamic changes,” says Faruki, assistant professor of anesthesiology at the University of Colorado Medical School. . “Patients can feel fear, they can feel claustrophobia, so we started thinking about how we can reduce the amount of sedative medication given intraoperatively for patients who are getting nerve block for upper extremity surgery. We thought, ‘Why not give them a distraction?’ »
This has led to recently published research investigating virtual reality (VR) immersion in relation to monitored anesthesia care for hand surgery.
“As virtual reality has continually grown in the medical sphere, we realized that immersive experiences through virtual reality had the potential to benefit patients as much as the intraoperative treatments we currently use,” says Faruki. “We decided to examine patient satisfaction in a pilot study comparing the experiences of the two groups.”
Virtual reality immersion during surgery
Faruki began this research as a resident at Beth Israel Deaconess Medical Center at Harvard Medical School, working with his faculty mentor Brian O’Gara, MD, who had an interest in reducing the associated effects of sedation in patients. who might not need it to manage the pain.
“We realize that a lot of the drugs we give to patients, intraoperative sedation, are safe but can have side effects – lower blood pressure, slower breathing,” Faruki says. “If virtual reality can have a similar effect on managing patient anxiety without the side effects associated with sedation, that’s something we should investigate.”
Faruki and his research partners randomized 40 participants who were undergoing elective hand surgery into two groups, one receiving intraoperative monitored anesthesia (MAC) care and the other using virtual reality in addition to receiving MACs. . They worked from a hypothesis that the intraoperative use of virtual reality would reduce the dose of sedatives during elective hand surgery without impairing patient satisfaction compared to MAC alone.
Participants in the VR group viewed the immersive programming of their choice through a head-mounted display during surgery. As a primary result, Faruki and his co-researchers measured the intraoperative dose of propofol, a common anesthetic, per hour. Secondary outcomes included patient-reported pain and anxiety, overall satisfaction, functional outcomes, and length of stay in the post-anaesthetic care unit (PACU).
Possibilities for VR technology
Patients in the VR group received significantly less propofol per hour than the MAC control group. Although there were no significant differences between the groups in overall satisfaction, PACU pain scores, or postoperative functional outcomes, participants in the VR group had a significantly reduced length of stay in PACU.
“A number of participants in the VR group said they were very aware but comfortable,” says Faruki. “The beauty of this is that if you have an effective way to manage pain for a specific surgery, you can give patients VR headsets, put them in an immersive environment, and as long as the nerve block doesn’t wear off, they can withstand surgery very comfortably.
Research participant using VR technology during elective hand surgery (left) and an example of the VR environment he might choose. (Image courtesy of Adeel Faruki, MD, MBA and co-investigators.)
An added benefit of VR apps during surgery is two-way communication with patients, says Faruki. “The VR screen lets you send messages to patients, so you can let them know how long the procedure will take or ask them how they’re feeling,” says Faruki. “The VR group also had a much higher amount of local anesthetic redose around the surgery site because they are awake and can communicate if they feel pain. Whenever your patients are heavily asleep, you often mask what you are managing, but with virtual reality, patients are fully awake. »
Faruki notes that he and his research colleagues weren’t studying pain reduction, but “if you can maintain an adequate experience for patients with less intraoperative sedation.” He adds that there is interest in replicating research done by O’Gara at Beth Israel Deaconess Medical Center, examining the use of virtual reality in joint repair surgery.
“We are looking to expand the use of virtual reality to more high-risk populations,” says Faruki. “Patients undergoing surgery for a hip fracture, for example, may be older or have more health problems and giving them sedation poses a much higher risk. If we can give them an adequate dose of medication in the spine, while keeping them awake and comfortable and holding them in an immersive environment, that creates an opportunity to reduce the risks associated with anesthesia.
It is also possible to study the use of virtual reality to reduce negative patient experiences in the surgical recovery unit, managing pain with non-pharmacological applications. “I really foresee many uses of VR technology in the future,” says Faruki, “not to remove the use of anesthesia, but to be a complementary treatment that benefits patients.”
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