Anxiolytic effect of virtual reality headset in upper extremity surgery: a prospective randomized trial

This study investigated whether virtual reality (VR) headsets reduce anxiety in patients undergoing upper extremity orthopedic surgery with regional anesthesia. The postoperative State-Trait Anxiety Inventory (STAI)-1 score was defined as the primary outcome. Secondary outcomes included pre–postoperative change in STAI-1, recovery quality, hemodynamics, sedation requirements, postoperative pain, analgesic use, and satisfaction. In this single-center, prospective, randomized, controlled, single-blind study, patients aged ≥ 18 years, ASA status I–III, Turkish-literate, and scheduled for elective upper extremity surgery under peripheral nerve block were enrolled. Preoperative demographic data were collected, and anxiety and recovery were assessed using the STAI and Quality of Recovery-15 (QoR-15) questionnaires. After baseline assessments, patients were randomized to either the VR group or control group. The VR group received a VR headset intervention preoperatively, during brachial plexus block, and throughout the intraoperative period, while the control group received standard care without VR. Postoperative pain, anxiety, recovery quality, and patient and surgeon satisfaction were recorded. Seventy-nine patients were included. No significant differences were found between groups in demographic data, education level, case type, or surgery duration. Preoperative STAI-1 and STAI-2 scores were similar (p > 0.05). Postoperatively, VR group showed significantly lower STAI-1 scores and greater reductions in STAI compared to control group (p < 0.05). Intraoperative anxiety was also significantly lower in VR Group. No significant differences were observed between groups for NRS pain scores, QoR-15 scores, hemodynamic variables, or satisfaction levels. Our findings indicate that VR videos used from the preoperative period to the end of surgery are associated with reduced perioperative anxiety. However, this anxiety reduction did not translate to improvements in pain, haemodynamic stability, recovery quality, and satisfaction. ClinicalTrials.gov, TRN: NCT06244654, Registration date:2024-01-19.