Carpal tunnel syndrome (CTS) is on the rise in the United States. This hand issue is caused by a compressed nerve at the wrist, and it disproportionately affects people who use computers for long periods or those with jobs requiring frequent repetitive movements. While CTS remains the most common type of arthritis, osteoarthritis (OA) — in which a joint’s cartilage breaks down — also affects an growing number of Americans. What these two conditions have in common is the need for hand surgeries, during which the patients are often sedated. And that sedation comes with risks, including respiratory failure, stroke, and heart attack. But now those risks may be mitigated with help from an unlikely tool: virtual reality in the OR.
Typically, a person undergoing hand surgery will get a regional anesthetic — usually a shot that numbs the hand before surgery — and anesthesia during the operation, which is often delivered intravenously, keeping patients groggy but awake. But a team at Harvard’s Beth Israel Deaconess Medical Center (BIDMC) sought a way to lessen this double dose of sedation with virtual-reality immersion. To test the method, they recruited a group of 34 hand-surgery patients and gave half of them VR headsets with noise-cancelling headphones. The 360-degree VR content, primarily nature scenes, was designed to induce calmness.
During the procedures, patients in both groups were given supplemental anesthetics if they asked, or if the anesthesia providers deemed more was necessary. The results? A significant number of the patients wearing VR headsets during their operations received less of the IV-administered sedative. Notably, the VR group got more of the local anesthesia than the control group, suggesting that targeted numbing is key to VR aiding in lowering the need for anesthetics during the operation. Post-op questionnaires revealed that there were almost no differences in the satisfaction levels between the VR group and the control group, while pain scores and pain management with opioids were likewise similar.
There was one notable difference between the two groups; patients in the VR group were discharged from the Post Anesthesia Care Unit (PACU) about 22 minutes before their control counterparts. BIDMC’s Dr. Brian P. O’Gara says, “Virtual reality’s purported benefit in the management of patients with pain or anxiety is through providing an immersive experience capable of distracting the mind from processing the unpleasantries associated with undergoing surgery. [And] with the increase in the amount of time people spend at the keyboard combined with our aging population, there is a projected increased need for common elective hand surgeries.”
