Virtual Reality as a Hypnotic Tool in the Management of Anxiety During the Performance of the Axillary Block

Abstract

Regional anaesthesia is a gold standard in upper limb orthopaedic surgery. Carried out on an awake patient, it can be a source of anxiety. In recent years, hypnotic techniques have been proposed in the management of perioperative anxiety. Among them, virtual reality is increasingly used as a distraction tool during anxious or painful actions despite the scarcity of proof of its benefit in the literature. Before implementing the systematic use of virtual reality when performing regional anaesthesia in our institution, we designed a study hypothesizing that the use of a virtual reality headset when performing an axillary block would reduce patient's anxiety. The study is an investigator-initiated, prospective monocentric and observational trial comparing anxiety scores of patients who underwent upper limb surgery under an axillary block with or without virtual reality headset. The perioperative anxiety was assessed by a numerical range scale before and after the peripheral nerve block performance. Between June 2021 and June 2022, 99 patients were included: 53 wearing the virtual reality headset and 46 not. The difference in numerical range scale for anxiety before and after the axillary block performance did not differ in the virtual reality group compared to the group without headset (mean = -1.9 ± 2.5 vs -1.5 ± 2.0, (p = 0.2520)). Technical difficulties reported by the operators were similar in both groups. Despite the large number of patients included, the virtual reality headset did not reduce patient's anxiety during a peripheral nerve block. Perioperative anxiety was low in all patients.

Keywords: Anaesthesia; Axillary block; Hypnotic tool; Perioperative anxiety; Virtual reality.