Research Summary

Virtual Reality Reduces Perioperative Anxiety, Pain, and Opioid Use in Total Hip Arthroplasty

Miranda Manier, BA

Key Highlights

  • Virtual reality (VR) reduced perioperative anxiety, stress, pain, and opioid requirements in patients undergoing total hip arthroplasty.
  • Patients in the VR group demonstrated significantly lower anxiety, stress, and cortisol levels, along with decreased analgesic and haloperidol use.
  • VR use led to longer time to first rescue analgesia and higher patient satisfaction compared with controls.

In a randomized controlled trial, the use of virtual reality (VR) during total hip arthroplasty (THA) was shown to significantly improve patient outcomes across several perioperative measures. Participants who engaged with immersive natural environments and calming music experienced reduced anxiety, stress, and pain, while also requiring fewer pharmacologic interventions.

THA is the standard treatment for advanced hip osteoarthritis and is among the most commonly performed orthopedic procedures worldwide. Despite its high success rate, patients frequently experience moderate to severe postoperative pain, as well as heightened perioperative anxiety. These factors can lead to increased physiological stress responses, delayed healing, and greater reliance on opioids and sedatives, which in turn may prolong hospital stays and increase healthcare costs. Prior research has suggested VR as a nonpharmacological intervention with potential benefits for pain and anxiety management, but its role in the perioperative setting of THA had not been fully evaluated.

This open-label, randomized controlled study was conducted at Tanta University, Egypt, and included 50 adult participants scheduled for elective THA under spinal anesthesia. Patients were randomized into two equal groups: a VR group, which experienced immersive natural scenes with soft background music via VR headset both before and during surgery, and a control group, which received standard care without VR. Anxiety and stress were assessed using validated scales (STAI-S and PSS-10), and pain was measured using the Numerical Rating Scale (NRS). Hemodynamic parameters, serum cortisol, haloperidol consumption, opioid use, time to first analgesic request, and patient satisfaction were also recorded. The primary outcome was perioperative anxiety, with secondary outcomes including stress, pain, pharmacologic requirements, and satisfaction.

Results demonstrated that patients in the VR group had significantly lower STAI-S and PSS-10 scores both before spinal anesthesia and immediately after surgery compared with controls (P < .05). Heart rate and mean arterial pressure were lower at multiple intraoperative time points in the VR group. Pain scores were significantly reduced at 4 and 6 hours postoperatively, and the time to first request for rescue analgesia was prolonged in the VR group (6.04 vs 5.04 hours; P < .001). Patients receiving VR also consumed less pethidine within 24 hours, required lower haloperidol doses, and had significantly lower postoperative cortisol levels (P < .05 for all). Overall satisfaction was higher in the VR group than in controls.

Study limitations include the modest sample size, single-center design, and open-label methodology, which precluded blinding and may have introduced bias. The reliance on self-reported outcomes and the exclusion of certain patient populations also limit generalizability.

“VR can reduce perioperative anxiety, stress, pain, and opioid requirements, and improve satisfaction in THA patients,” Moharam and colleagues concluded.

Reference
Moharam SA, ElSharkawy MS, ELkashef AM, Romeih MA, El Rasool AOAR, Shaheen MM. Effect of virtual reality on perioperative anxiety, stress and pain in total hip arthroplasty: a randomized controlled trial. BMC Anesthesiol. 2025;25(1):446. doi:10.1186/s12871-025-03316-3