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

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.