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Year : 2022  |  Volume : 1  |  Issue : 1  |  Page : 40-44

The effect of virtual reality technology on reducing pain and stress during arterial catheter placement

Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Date of Submission16-Dec-2021
Date of Decision13-Jan-2022
Date of Acceptance23-Feb-2022
Date of Web Publication23-Mar-2022

Correspondence Address:
Lida Fadaizadeh
Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpdtsm.jpdtsm_4_22

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BACKGROUND: Different pharmacological ways for pain and stress control exists, but still, there is space for alternative therapeutic methods and researchers are looking for novel ways to achieve this goal. The aim of this study was to evaluate the role of virtual reality (VR) in reducing pain and stress during minor interventions such as arterial line placement.
METHODS: In this study, patients who were candidates for arterial catheter placement before anesthesia induction were selected. Eligible patients were randomly divided into case and control groups. After obtaining consent from both groups and applying local anesthesia, the procedure was performed while displaying a film by VR camera for case group. After the procedure, pain, stress, and satisfaction levels were asked from patients. Pain score was measured by Visual Analog Scale score and during the procedure, vital signs were recorded to detect changes.
RESULTS: The results in case and control patients showed that 47.5% of patients in case group and 22.5% of patients in control group had pain (P value = 0.019). Considering stress, respectively, 32.5% and 45% of the patients in the control and case groups reported positive (P = 0.251). Intergroup comparison of vital signs showed no significant difference between the case and control groups.
CONCLUSIONS: According to the results, patients in case group experienced more pain and stress in comparison to the control group which shows that using the new technology was not quite acceptable. Therefore, we recommend the patients experience and be familiarized with the new device in normal condition before using it for procedures.

Keywords: Arterial catheter, pain management, telemedicine, virtual reality

How to cite this article:
Fadaizadeh L, Sanaat M, Taheri SM, Sistani M. The effect of virtual reality technology on reducing pain and stress during arterial catheter placement. J Prev Diagn Treat Strategies Med 2022;1:40-4

How to cite this URL:
Fadaizadeh L, Sanaat M, Taheri SM, Sistani M. The effect of virtual reality technology on reducing pain and stress during arterial catheter placement. J Prev Diagn Treat Strategies Med [serial online] 2022 [cited 2022 May 24];1:40-4. Available from: http://www.jpdtsm.com/text.asp?2022/1/1/40/340554

  Background Top

The use of an arterial catheter is a common method for continuous monitoring of blood pressure and blood gas analysis in the operating room and intensive care unit (ICU).[1] Placement of an arterial catheter is a painful process and its insertion usually requires local anesthesia and sedation for the patients. Induction of sedation in patients is a drug-dependent process varying across a spectrum from light to deep.[2] However, alternative means of mental distraction and sedation can also be used to calm the patients for performing minimally invasive procedures, especially when patients are considered high risk for anesthetic drug administration.

The virtual reality (VR) distraction technique is an adjunctive therapy, used since 2003, to induce sedation in patients and control pain and anxiety.[3],[4] A pilot study utilized the oculus rift headset for orthopedic procedures and showed that using VR as an adjunctive nonpharmacological sedative is effective in reducing pain.[5]

This technology is provided by a special camera that makes the individual experience a virtual world with different visual, auditory, and other perceptions, and in fact, distracts the mind from the painful procedure and as a result reduces sedative drug requirements and eventually pain and stress in patients.[6]

The main aim of this study was to evaluate the effect of VR technique in reducing pain perception and analgesic drug requirement for performing minimally invasive procedures.


In the present study, patients who were candidates for major surgery requiring arterial catheter placement were selected based on the inclusion (i.e., patients who were candidates for major surgery requiring arterial catheter placement, age above 20 years, and signing the informed consent form) and exclusion criteria (i.e., history of mental illness, history of drug addiction, alcohol addiction, lack of consciousness, any lesions in the head prohibit the use of a VR camera). The selected subjects were then assigned to the case and control groups sequentially.

This project was approved and registered by the National Research Institute of Tuberculosis and Lung Disease ethical committee (IR.SBMU.NRITLD.REC.1396.424).

Local anesthesia at puncture site was induced using 1 mL of 2% lidocaine in both groups. No intravenous drug was used for performing the procedure. In the case group, in addition to this, arterial catheter placement was performed while using the VR headset (Samsung Gear VR powered by Oculus). The patients were asked to choose the type of relaxation videos among seaside, jungle and underwater videos and the VR headset was placed on their face 15 min before performing the procedure. For the control group, only local anesthesia was used and the procedure was performed after 5 min of injection.

Arterial line placement was performed using a 20 gauge cannula. At the end of the catheter placement, the patients were asked to score the level of pain they experienced based on Visual Analog Scale (VAS). An anxiety self-report scale was also used to determine the level of anxiety patients had during the procedure. The heart rate and blood pressure of the subjects were recorded every 5 min during the catheter placement.

All data analysis was performed by SPSS 26.0 (IBM Corporation, Armonk, New York, USA). Demographic data (age, gender), parameters including patient satisfaction, procedure duration, pain, and stress were analyzed using Chi-square test. For analyzing vital sign variation and first-last difference t-test, Mann–Whitney, paired t-test, and Wilcoxon-test were performed.

  Results Top

After an 8-month intervention, the results showed that a total of 80 patients participated in the study through the case and control groups, 40 subjects in each. The mean age of the study subjects was 48.16 ± 14.26 years; 60% were male. Regarding the statistical analysis of data, 47.5% and 22.5% of the patients in the case and control groups, respectively, reported the feeling of pain, showing a significant difference between the two groups (P = 0.019) [Graph 1]. In addition, 32.5% and 45% of the patients in the control and case groups, respectively, reported experiencing stress, indicating no significant difference between the two groups (P = 0.251) [Graph 2]. The results showed that the placement of an arterial catheter in 30% of the subjects in the case group was performed within 1–5 min, while it took more than 5 min in 45% of the subjects in the control group (P = 0.024) [Graph 3].

Intergroup comparison of vital signs showed no significant difference between the case and control groups. Within-group comparisons also showed no significant differences between the first and last vital signs, except for the diastolic pressure in the control group which a significant difference was observed (P = 0.005) [Table 1].
Table 1: Mean measures of vital signs and mean difference between first and last measures of vital signs in case and control groups

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Statistical analysis of data showed no significant relationship between the level of satisfaction and the mean age of the subjects (P = 0.779) [Graph 4]. In addition, no significant relationship was found between the mean age of the subjects and their reported level of pain (P = 0.691). There was also no significant relationship between gender and the level of pain reported by patients (P = 0.924).

The level of pain was assessed using the VAS score, and no significant differences were observed between the mean scores of the two groups. The Mann–Whitney test was employed to evaluate the relationship between VAS score and patients' satisfaction, and the results showed weakly significant relationship (P = 0.067).

  Discussion Top

Arterial catheter placement is one of the painful procedures for patients, whether in the operating room or ICU. The use of appropriate methods to reduce anxiety and pain with minimal side effects has always been considered important. Induction of anesthesia and sedation, which is the routine method for management of painful procedures in the operating room or ICU, is a drug-dependent procedure performed by opioids and hypnotics. The use of such agents alone or in combination causes different degrees of sedation.[7] Considering the side effects of sedation and anesthesia, especially in unstable patients, alternative methods should be introduced to deliver lower doses of drugs to patients.[8]

The use of new technologies for relaxing and mentally distracting patients is a raising topic; VR is one of the main. The use and application of this technology in various medical disciplines are growing. VR technology is an adjunctive therapy for anxiety disorders such as illness-induced anxiety and claustrophobia.[8],[9],[10] Today, it is increasingly used in neurology for stroke rehabilitation, in speech therapy, and to induce sedation during endoscopy, dentistry, etc.,[11],[12],[13] A review study by Malloy and Milling on venous catheters placement reported that the employment of VR technology could be effective in reducing pain and anxiety during the procedure.[14] In a study conducted in 2019 on war veterans with chronic pain, VR technology and a specially developed application were used to make a virtual environment for patients, and their effects on helping to overcome the fear of mobility were examined. Ease of use and self-management were reported as the advantages of the introduced method and generally matched to the patients' needs.[15]

A study, in addition to placebo, used a VR camera to examine the gait ability in patients with Parkinson's disease, and the results showed that the technology failed to improve patients' gait but reduced the stride interval.[16] In a study by Walker et al.(2014), a VR camera was used to control and reduce pain and anxiety in patients during cystoscopy, and the results showed no significant differences between the case and control groups.[17] Furthermore, in a study by De Miguel-Rubio (2020) on patients with spinal cord injury, rehabilitation was done for low activity and no significant differences were observed between the controls and patients who used VR cameras.[18]

There was no significant difference in terms of age between the control and case groups in the present study. On the other hand, the satisfaction of patients in the control group was higher than that of the ones in the case group; hence, age and therefore familiarity with new technologies have no effect on patient's satisfaction. Furthermore, the level of stress in the case group subjects was higher than that of controls, which may indicate that the VR cameras played a role in increasing stress in patients. This finding highlights the importance of knowledge and awareness; the effectiveness of VR in reducing anxiety and stress is achieved when patients are first trained and fully acquainted before using the technology.

Although the results of various studies confirmed the efficacy of using VR technology,[14],[19],[20],[21],[22] as previously mentioned, in some studies, the results were not satisfactory or decisive and surprisingly, the findings of our study were in contradiction with those of most previous studies. The provision of a suitable bed for patients to obtain the proper effect of VR technology seems essential. Familiarizing patients with VR cameras, the experience of using the camera before undergoing the procedure, and training in working with the camera can reduce the fear of the first encounter. In addition, the results of other studies also confirm that people with higher education, those familiar with computer use, and patients in youth age are more positively affected by VR technology compared to the elderly.[23],[24]

  Conclusions Top

As a conclusion, if VR is intended to be used as an alternative to usual anesthesia and analgesic methods for pain reduction, we recommend meticulous patient selection and individualization of the method according to the patient's level of education and interests. Moreover, the patients should experience and be familiarized with the new device in normal condition before using it for procedures. This method of pain and stress reduction may be a promising alternative for usual analgesic techniques, but it must be tailored to the needs of each patient and must be experienced in advance to achieve best results. Acute pain control is an essential part of strategic planning for better delivery of health care now a day. Therefore, finding the best and most efficacious method on the one hand and the least invasive means of pain control on the other hand is a major goal. With the advent of new information and visual technologies, such as VR, pain can be controlled easily using visual distraction, but as a rule, new inventions require adequate training and familiarizing to be acceptable. We propose that strategic planning for utilizing these new technologies be taken into consideration by health-care policymakers to make the best use of these new noninvasive methods in modern medicine.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Walker MR, Kallingal GJ, Musser JE, Folen R, Stetz MC, Clark JY. Treatment efficacy of virtual reality distraction in the reduction of pain and anxiety during cystoscopy. Mil Med 2014;179:891-6.  Back to cited text no. 17
De Miguel-Rubio A, Rubio MD, Salazar A, Camacho R, Lucena-Anton D. Effectiveness of virtual reality on functional performance after spinal cord injury: A systematic review and meta-analysis of randomized controlled trials. J Clin Med 2020;9:2065.  Back to cited text no. 18
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