Anesthesia Alert: Can VR Enhance the Patient Experience?

Surgical professionals know opioids are not always the best way to control post-op pain, yet many still focus on using the drugs to help patients feel comfortable after surgery. It’s time to employ other treatments, even if it means thinking outside the box. Enter virtual reality (VR). Studies show the technology reduces acute pain and anxiety during medical procedures.

When it was discovered that our same-day robotic hysterectomy patients were the second-highest consumers of opioids in the PACU, despite having undergone a minimally invasive and innovative procedure, we decided to find out if adding VR to our multimodal analgesia regimen would reduce their pain levels. The research project involved 64 patients, 22 of whom received VR combined with multimodal analgesia, which included some combination of acetaminophen, NSAIDs, COX-2 inhibitors and gabapentin/pregabalin. The patients were given VR headsets in pre-op and could choose from a variety of relaxing and meditative experiences, such as sightseeing in London or swimming with dolphins. Before undergoing anesthesia, patients had the option to utilize VR for as little as five minutes or for up to 30 minutes. 

Pain is influenced by anxiety. When patients feel anxious during the surgical experience, the amount of pain they feel can increase. VR puts patients in a more relaxed emotional state because the modules help to ease their worries. It diverts their attention from the pain they might feel or are expecting to feel.

Even though the results of the study showed no statistically significant difference in opioid consumption between the patient groups — 20.52 morphine milligram equivalents (MME) in patients who did not use VR compared with 21 MME in patients who did — there were other positive and unexpected outcomes.

• Easier IV starts. Pre-op nurses found VR to be a very helpful tool during IV starts. Patients who don’t like needles donned headsets to take their mind off the task and let the nurses do their job safely and efficiently. The patients were calm and smiling as they swam with virtual dolphins while nurses inserted their IVs.

• Improved medication use. Although we found no statistically significant difference in total opioid consumption between the patient groups, there was a statistically significant difference in multimodal analgesia administered. After initiating the VR program, nurses were more likely to administer a combination of non-opioid medications preoperatively as part of the study, which had a positive impact on the patient’s postoperative pain. The study’s results showed the multimodal analgesia that was administered in pre-op was working, because many patients didn’t complain of pain after their procedures and therefore were not given VR headsets.

The VR program allowed nurses to adopt novel evidence-based practices and promoted the use of non-opioid and non-pharmacological interventions. Although the combination of multimodal analgesia and VR did not reduce opioid consumption, the practice of incorporating multimodal analgesia as a standard workflow improved, and perioperative clinical staff knowledge of non-opioid medications increased.

VR puts patients in a more relaxed emotional state.

• Better communication. The great thing about VR is patients can pick out the meditative module they like the best and that helps them to relax. Nurses in the PACU were alerted to the patient’s preference and that module was readied for use as needed.

It was exciting to witness the conversations that were happening between pre-op nurses and their patients. The nurses were engaged with patients and getting them involved in their pain plan. They discussed their preferences for the VR modules and talked about what to expect post-op during recovery. The technology gave the nurses a reason to initiate a conversation about pain management with their patients, which is not always something that happens. Patients could tell we cared about controlling their pain, and that we wanted to manage it effectively without opioids. This open and honest communication can empower patients to speak up after surgery if they experience discomfort.

Poorly controlled postoperative pain is prevalent. Surgical patients report feeling pain 80% of the time with levels ranging from moderate to severe and extreme. Having patients return for follow-up care because of uncontrolled pain is something all facilities want to avoid, because it contributes to higher readmission rates and healthcare expenditures — unresolved postoperative pain costs the U.S. healthcare system between $1,869 and $4,553 per patient. Whatever you can do to help tackle the opioid crisis by implementing non-pharmaceutical interventions is important to comprehensive, high-quality surgical care. Adding VR to a multimodal pain management program contributes to an opioid-sparing culture that improves how patients feel before and after surgery. OSM