Departments of Plastic Surgery.
Anaesthetics and.
Pain. 2024 Apr 1;165(4):741-752. doi: 10.1097/j.pain.0000000000003086. Epub 2023 Oct 23.
Procedural anxiety and pain negatively affect surgical outcomes and the patient experience during awake, invasive procedures (AIPs). This systematic review aims to evaluate the effect of using virtual reality (VR) to enhance the intraprocedural patient experience during AIPs. PRISMA, Cochrane, and SWiM Reporting Items guidelines were followed. PubMed, EMBASE, CENTRAL, and medRxiv databases were systematically searched for randomised controlled trials (RCTs) investigating the use of immersive VR headsets to enhance the patient experience in adults undergoing AIPs. Sixteen studies were included. The VR and control groups comprised 685 and 677 patients, respectively. Patients underwent endoscopic procedures in 9 studies ("endoscopic") and interventions that involved a skin incision in 7 studies ("incision"). Eleven (of 13) studies demonstrated a favourable effect on procedural anxiety with VR use compared with standard intraprocedural care (85% [95% CI: 46%-100%], P = 0.011). Ten (of 13) studies demonstrated a favourable effect on pain with VR use (77% [95% CI: 38%-100%], P = 0.046). Seven (of 9) studies demonstrated a favourable VR effect on patient satisfaction (78% (95% CI: 44%-100%), P = 0.070). The effect of VR on physiological markers of anxiety and pain and requirements for additional pro re nata (PRN) analgesia and sedation were not clear. No significant differences in patient experience were identified between the "incision" and "endoscopic" subgroups. This review demonstrates that VR can feasibly be used to enhance the patient experience during AIPs by attenuating subjective perceptions of procedural anxiety and pain. However, further RCTs are required to elucidate the effect of VR on more objective measures of the patient experience.
程序性焦虑和疼痛会对手术结果和清醒、有创性手术（AIP）期间的患者体验产生负面影响。本系统评价旨在评估使用虚拟现实（VR）来增强 AIP 期间患者手术体验的效果。遵循 PRISMA、Cochrane 和 SWiM 报告项目指南。系统地检索了 PubMed、EMBASE、CENTRAL 和 medRxiv 数据库，以查找调查在接受 AIP 的成年人中使用沉浸式 VR 耳机增强患者体验的随机对照试验（RCT）。纳入了 16 项研究。VR 和对照组分别包括 685 名和 677 名患者。9 项研究中的患者接受了内镜检查（“内镜”），7 项研究中的患者接受了涉及皮肤切口的干预（“切口”）。11 项（13 项中的 11 项）研究表明，与标准术中护理相比，使用 VR 可显著降低程序性焦虑（85%[95%CI：46%-100%]，P = 0.011）。10 项（13 项中的 10 项）研究表明，使用 VR 可显著降低疼痛（77%[95%CI：38%-100%]，P = 0.046）。7 项（9 项中的 7 项）研究表明，VR 对患者满意度有积极影响（78%[95%CI：44%-100%]，P = 0.070）。VR 对焦虑和疼痛的生理标志物以及对额外按需镇痛和镇静的需求的影响尚不清楚。“切口”和“内镜”亚组之间未发现患者体验的显著差异。本综述表明，VR 可通过减轻患者对手术过程中焦虑和疼痛的主观感知，有效地增强 AIP 期间的患者体验。然而，需要进一步的 RCT 来阐明 VR 对患者体验的更客观测量的影响。
