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  • Dr Kevin Rafferty FRCA

Awake during Surgery? It's ok It's Regional!

J Clin Med. 2020 Jan 13;9(1). pii: E215. doi: 10.3390/jcm9010215.


Virtual Reality for PEripheral Regional Anesthesia (VR-PERLA Study).


Alaterre C1, Duceau B2, Sung Tsai E3, Zriouel S1, Bonnet F1, Lescot T1, Verdonk F1,3,4.

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1Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France.2Department of Anaesthesiology and Intensive Care, Hôpital européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France.3Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.4Sorbonne University, 75006 Paris, France.


Abstract When used as an add-on to regional anesthesia, virtual reality (VR) has been reported to provide anxiety-reducing benefits and sedation-sparing effects. However, its impact on patient satisfaction is still a matter of controversy. We investigated the feasibility and benefits of implementing intraoperative VR distraction in a French University Hospital (Hôpital Saint-Antoine, AP-HP). This monocentric observational before-after study included 100 patients who underwent ambulatory upper limb surgery under peripheral nerve block in January 2019, 50 before and 50 after implementation of an intraoperative VR distraction protocol. Primary outcome was patient self-rated satisfaction score evaluated right after surgery. Secondary outcomes included 2-month patient-reported satisfaction score, perioperative self-rated anxiety and intraoperative hemodynamic changes. Compared to former standard care, VR distraction was associated with significantly higher postoperative satisfaction scores (10 [IQR 9; 10] vs. 9 [8; 10], p < 0.001) still reported two months after surgery (10 [10;10] vs. 10 [8.5;10], p = 0.06). Patient median intraoperative anxiety score was lower in the VR group, compared to Standard Care group (0 [0; 2] vs. 3 [0.25; 7], p < 0.001), and occurrence of intraoperative hemodynamic changes was also lessened in the VR group (2% vs. 16%, 0R = 0.11[95% CI 0.002-0.87], p = 0.031). The present findings suggest that VR distraction program in the operating room could effectively improve patient satisfaction with anxiety-reduction and hemodynamic benefits.


Kevin's opinion


Again these studies all point to better patient satisfaction with VR.


This group of French researchers already provided high quality care.


This is not a blinded trial.


A goal of the Rafferty Distraction Headset is routine use of affordable VR in regional procedures.



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