Virtual reality to reduce pain and anxiety during the removal of chest drains after cardiac surgery: A randomized controlled trial.

INTRODUCTION

Removal of chest drains after cardiac surgery is ranked among the most painful procedures in the intensive care units. Virtual reality, as an entertaining, non-pharmacological tool, may help for managing procedural pain and anxiety, although its efficacy in this context remains uncertain.

OBJECTIVE

To assess the efficacy of virtual reality on acute pain and anxiety during chest drain removal and to evaluate patient satisfaction with the intervention.

METHODS

An open-label, randomized controlled trial was conducted in a cardiac surgery unit in a tertiary-level university hospital with 101 spontaneously breathing post-cardiac surgery patients who were able to communicate. Participants were randomized to undergo virtual reality-guided removal of chest drains (Intervention Group) or to receive usual care without distraction (Control Group). Self-reported pain (Numeric Rating Scale) and state-anxiety scores through the 20-item of the State-Trait Anxiety Inventory-State Scale (STAI-s) were assessed at baseline, 1-minute, and 30-minutes post-procedure. Satisfaction levels and adverse events with the intervention were also monitored.

RESULTS

Analysis of 98 patients (48 in the intervention group and 50 in the control group) showed similar baseline characteristics between groups. Two-way ANOVA for repeated measures showed a non-significant effect of the interaction between time-treatment for pain (MD = 0.16; 95%CI: -0.7 to 1.03; F1,96 = 0.14; p = 0.71) and state-anxiety (MD = -1.83; 95% CI: -4.5 to 0.88; F1,96 = 1.79; p = 0.18). Patient satisfaction with the virtual reality experience was high with a mean score of 8.3 (SD = 1.9) points.

DISCUSSION: The findings suggest that the effect of virtual reality on managing procedural pain and anxiety might be modelled by individual and contextual factors, such as improvements in patient's clinical situation.

CONCLUSION

Compared with usual care, virtual reality did not significantly reduce pain and anxiety during the removal of chest drains after cardiac surgery, although patients rated the experience with a high level of satisfaction.