Virtual reality for reduction of intraprocedural pharmacological sedation and analgesia in adult patients: A systematic review and meta-analysis.

Abstract

Background: Pharmacological sedation and analgesia are used to alleviate discomfort during awake medical procedures but can cause adverse effects like apnea and hypoxemia, increasing the need for airway management and prolonging recovery. Virtual reality (VR) has emerged as a non-pharmacological intervention to reduce the need for procedural sedatives and analgesics.

Methods: A systematic review and meta-analysis were conducted, assessing the impact of VR immersion on intraprocedural sedation and analgesia usage in adults (≥ 18 years). We searched MEDLINE (PubMed), Embase, Cochrane CENTRAL, and Web of Science from inception to August 1 st, 2024. We included analytical studies utilizing VR immersion in the intervention arm, and reporting tailored dosages of intraprocedural sedatives (propofol, midazolam) and/or opioids. Statistical analyses used standardized mean differences (SMD), and heterogeneity was assessed with I².

Results: Of 2714 identified papers, 11 (560 patients) were included. VR significantly reduced propofol usage (SMD = -1.70; 95% CI -3.10 to -0.31; P = 0.02; I² = 92%) and midazolam usage (SMD = -0.29; 95% CI -0.57 to 0.00; P = 0.05; I² = 0%). However, our analysis showed no reduction in opioid usage (SMD = -0.21; 95% CI -0.60 to 0.19; P = 0.31; I² = 74%) in the VR group.

Conclusions: VR immersion effectively reduces the required dose of intraprocedural sedatives, but its impact on opioid consumption remains unclear, especially in the absence of regional or neuraxial anesthesia. Further research is needed to clarify these effects and optimize VR use in clinical practice.

Registration: This review's protocol was prospectively registered on PROSPERO (CRD42024569462).