From the Pediatric Research in Emergency Therapeutics Program, Goldman's Pain Laboratory, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Research Institute; Division of Plastic Surgery, British Columbia Children's Hospital and University of British Columbia; Sauder School of Business, University of British Columbia; and Emergency Department, Peace Arch Hospital, Department of Emergency Medicine, University of British Columbia.
Plast Reconstr Surg. 2021 Aug 1;148(2):400-408. doi: 10.1097/PRS.0000000000008196.
Virtual reality has been used to alleviate pain and anxiety in a variety of medical procedures. The authors sought to explore the effects of virtual reality in common awake minor plastic surgery procedures where children may experience discomfort.
A randomized controlled trial compared virtual reality to standard-of-care distraction among children aged 6 to 16 years undergoing awake minor plastic surgery procedures at a quaternary children's hospital. Primary outcome was change in Faces Pain Scale-Revised pain score, and secondary outcomes included change in Venham Situational Anxiety Scale score, procedure duration, administration of local anesthetic, and pain/anxiety management satisfaction.
Mean pain and anxiety scores were similar in both groups (p = 0.60 and p = 0.18, respectively), and procedure duration was shorter with virtual reality (22 minutes versus 29 minutes; p = 0.002). Duration remained shorter in a linear regression model accounting for procedure type (p = 0.01). Similar proportions of children received additional local anesthetic after the initial dose (virtual reality, n = 6; standard of care, n = 9; p = 0.19) and median pain management satisfaction was similar (virtual reality, 9 of 10; standard of care, 9 of 10; p = 0.41). Median anxiety management satisfaction was similar (virtual reality, 9 of 10; standard of care, 9 of 10; p = 0.05). Younger children reported more "fun" than older children with virtual reality (p = 0.02). Surgeons reported interest "using virtual reality again" in 83 percent of cases.
The use of virtual reality for awake pediatric plastic surgery reduced procedure time but not pain or anxiety compared to standard of care in children aged 6 to 16 years. Virtual reality was safe and well-liked and should be considered as an additional tool. Increased efficiency may allow more cases to be performed.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
虚拟现实已被用于缓解各种医疗程序中的疼痛和焦虑。作者试图探讨虚拟现实在儿童可能感到不适的常见清醒小型整形手术中的作用。
一项随机对照试验比较了虚拟现实与标准护理分散注意力在 6 至 16 岁接受清醒小型整形手术的儿童中在一家四级儿童医院的作用。主要结果是改变修订后的面部疼痛量表疼痛评分，次要结果包括变化情境焦虑量表评分，手术持续时间，局部麻醉剂的管理和疼痛/焦虑管理满意度。
两组的平均疼痛和焦虑评分相似（p = 0.60 和 p = 0.18），虚拟现实组的手术时间更短（22 分钟对 29 分钟；p = 0.002）。在考虑手术类型的线性回归模型中，持续时间仍然较短（p = 0.01）。在初始剂量后接受额外局部麻醉的儿童比例相似（虚拟现实，n = 6；标准护理，n = 9；p = 0.19），中位数疼痛管理满意度相似（虚拟现实，10 分之 9；标准护理，10 分之 9；p = 0.41）。焦虑管理满意度中位数相似（虚拟现实，10 分之 9；标准护理，10 分之 9；p = 0.05）。使用虚拟现实的年龄较小的儿童比年龄较大的儿童报告更多的“乐趣”（p = 0.02）。外科医生报告有兴趣“再次使用虚拟现实”在 83％的病例中。
与标准护理相比，6 至 16 岁儿童清醒的小儿整形外科手术中使用虚拟现实技术可减少手术时间，但不会减轻疼痛或焦虑。虚拟现实是安全且受欢迎的，应被视为一种额外的工具。提高效率可能会使更多的病例得以实施。
临床问题/证据水平：治疗，II 级。
