By Rachel Sauer
Anesthesiologist Adeel Faruki, MD, MBA, works with patients to manage pain and anxiety, and for patients having hand surgery, managing anxiety is a significant concern.
That’s because those patients typically receive a nerve block rather than sedation or general anesthesia.
“If a nerve block is done, what we’re generally managing intraoperatively is anxiety and hemodynamic changes,” explains Faruki, assistant professor of anesthesiology. “Patients may feel fear, they may feel claustrophobia, so we started asking how we can reduce the amount of sedative medications given intraoperatively for patients who receive nerve block for upper extremity surgery.
“We thought, ‘Why don’t we offer them a distraction?’”
The question led Faruki to conduct research comparing virtual reality (VR) immersion to monitored anesthesia care for hand surgery.
“As VR has continually grown into the medical sphere, we realized that immersive experiences through VR have the potential to benefit patients as much as the intraoperative treatments we currently use,” Faruki says. “We decided to look at patient satisfaction in a pilot study comparing the two groups’ experiences.”
Faruki began this research when he was a resident at Beth Israel Deaconess Medical Center and Harvard Medical School, working with a faculty mentor who had an interest in reducing the associated effects of sedation with patients who may not need it to manage pain.
“We’re realizing that a lot of the medications we’re giving patients, the intraoperative sedation, are safe but can carry side-effects – dropping blood pressure, slowed breathing,” Faruki says. “If VR can have a similar effect of managing patient anxiety without with the side effects associated with sedation, that’s something we should be studying.”
Faruki and his research partners randomized 40 participants who were having elective hand surgery into two groups: One received intraoperative monitored anesthesia care (MAC) and one used VR in addition to receiving MAC.
They expected intraoperative VR use would reduce sedative dosing during elective hand surgery without detracting from patient satisfaction as compared to MAC. Participants in the VR group viewed immersive programming of their choice via a head-mounted display during surgery.
As a primary outcome, Faruki and his colleagues measured intraoperative dose of propofol, a common anesthetic, per hour. Secondary outcomes included patient-reported pain and anxiety, overall satisfaction, functional outcome, and length of stay in the post-anesthesia care unit (PACU) length of stay.
Patients in the VR group received significantly less propofol per hour than the MAC control group. Participants in the VR group had a shorter stay in the PACU, though there were no significant differences between groups in overall satisfaction, PACU pain scores, or postoperative functional outcome.
“A number of participants in the VR group stated that they were very aware but comfortable,” Faruki says. “The beauty of this is, if you have an effective way to manage pain for a specific surgery, you can give patients VR headsets, get them in an immersive environment, and as long as the nerve block doesn’t wear off, they can very comfortably endure surgery.”
Another benefit of VR applications during surgery is two-way communication with patients, Faruki says.
“The VR group also had a much higher amount of redosing of local anesthetic around the surgery site because they’re awake and can communicate whether they’re feeling any pain,” Faruki says.
There are other scenarios where the use of VR may be an appropriate option, Faruki says, such as with older patients or those who have more health conditions where giving them sedation is much higher risk.
“I really do foresee a lot of uses for VR technology in the future,” Faruki says, “not to take away from the use of anesthesia, but to be a complementary treatment that benefits patients.”