A Virtual Reality System for Pain and Anxiety Management during Outpatient Hysteroscopy- A Randomized-Control Trial.

BACKGROUND Visual and acoustic virtual reality (VR) has been increasingly explored as a non-pharmacological tool for pain relief in clinical settings. OBJECTIVE We aimed to evaluate the effectiveness of VR as a distraction technique in the management of acute pain during operative hysteroscopy in the outpatient setting. METHODS A prospective, open-label, randomized control trial in a tertiary university-affiliated medical center between April to August 2020. Overall, 82 women were randomly allocated to undergo operative hysteroscopy either with the use of VR (n = 44, study group) or with standard treatment (control group, n = 38). VR was applied throughout the procedure and no anesthesia was given. The primary outcome measures included self-reported intraoperative pain. Other objectives included vital parameters as pulse rate (PR) and respiratory rate (RR) before and during the first 3 minutes of the procedure. Pain and anxiety outcomes were measured as numeric rating scores. RESULTS The baseline parameters were similar between groups. The mean duration for the procedure was 8.1 ±3.2 vs. 7.3± 6.0 minutes for the study and the control groups (p = 0.23). There were no statistically significant differences between the reported pain scores during the procedure [median (interquartile range) 5.0 (3.0-7.2) vs 5.0 (3.0-8.0), respectively; P = .67]. While neither intraoperative heart rate nor respiratory rate differed between groups [14.0 (13.0-16.0) vs 14.0 (11.0-16.5); P = .77)], the increase of heart rate was found greater in the VR group [+7.0 (8.5) vs. +1.0 (12.2); P = .01]. CONCLUSION VR was not effective in reducing pain during an outpatient operative hysteroscopy.