Virtual Reality for Anxiety and Pain Management in Lower Limb Orthopedic Surgery Under Spinal Anesthesia: A Randomized Controlled Trial

ABSTRACT Background and Aims Patients undergoing lower limb orthopedic surgery under spinal anesthesia often experience significant perioperative anxiety and discomfort. Virtual reality (VR) has emerged as a promising non‐pharmacological intervention for anxiety and pain management. This study aimed to investigate the efficacy of VR as a complementary method for improving perioperative anxiety and pain management in patients undergoing lower limb orthopedic surgery under spinal anesthesia. Methods This prospective, single‐center, randomized, single‐blind trial included two groups: a VR group, receiving perioperative VR exposure, and a control group with standard care. The primary outcome was perioperative anxiety reduction measured using the State‐Trait Anxiety Inventory‐6 (STAI‐6) from preoperative period to after surgery. Secondary outcomes included pain intensity, sedative and analgesic medication consumption, hemodynamic stability, postoperative complications, and satisfaction of patients, anesthesia, and surgical teams. A total of 160 patients were randomized into 2 groups, of whom 60 per group were included in the final analysis. The trial was registered with the Pan African Clinical Trial Registry (PACTR202507660086282) and ClinicalTrials.gov (NCT07134764). Results The VR group demonstrated significantly lower postoperative anxiety levels compared to controls, with intense anxiety occurring less frequently (25% vs. 50%, p = 0.005). STAI‐6 scores showed marked reduction in the VR group (36.5 ± 7.92 vs. 46.72 ± 2.58, p < 0.001). Midazolam consumption was significantly reduced in the VR group (20% vs. 53.3%, p = 0.001). The VR group experienced significantly fewer postoperative complications including nausea (18.3% vs. 36.7%, p = 0.025) and headache (16.7% vs. 35%, p = 0.002). Patient satisfaction was significantly higher in the VR group, with dissatisfaction rates dramatically lower (3.3%vs.43.3%, p < 0.001). Both anesthesia and surgical teams reported higher satisfaction when managing VR group patients. Conclusion VR distraction significantly reduces perioperative anxiety, decreases sedative medication requirements, reduces postoperative nausea and headaches, and improves satisfaction.