Virtual Reality as an Intervention for Intraoperative Anxiety and Stress in Regional Anesthesia: A Randomized Controlled Trial

Abstract

ABSTRACT Background Regional anesthesia, while offering numerous clinical advantages, can paradoxically heighten intraoperative anxiety and stress due to patients remaining conscious throughout surgical procedures. Objectives This study aimed to evaluate the impact of immersive virtual reality (VR) on intraoperative anxiety, stress markers, and patient satisfaction in patients undergoing elective surgery under regional anesthesia. Methods A prospective, randomized controlled trial was conducted from 20 July to 20 September 2024 at Rafidia Governmental Surgical Hospital, Nablus, Palestine. A total of 145 patients undergoing elective surgery under regional anesthesia were randomly assigned to either a VR group ( n = 72) receiving immersive VR therapy using VR headset devices with standardized nature‐based environments during intraoperative period, or a control group ( n = 73) receiving standard hospital protocol care. Outcomes included anxiety assessed via State‐Trait Anxiety Inventory (STAI) and stress levels measured using Perceived Stress Scale (PSS‐10). A per‐protocol analysis was conducted for the primary outcomes. Results The VR group demonstrated significantly reduced postoperative state anxiety scores (37.2 ± 15.3 vs. 52.9 ± 15.7, p < 0.001; Cohen's d = 1.01) and sustained trait anxiety reduction (40.1 ± 13.5 vs. 53.3 ± 15.0, p < 0.001; Cohen's d = 0.94). Perceived stress levels were significantly lower in the VR group postoperatively (21.1 ± 5.3 vs. 25.9 ± 5.8, p < 0.001; Cohen's d = 0.87). Patient satisfaction scores were substantially higher in VR group (8.6 ± 1.2 vs. 6.1 ± 1.7, p < 0.001; Cohen's d = 1.73). Postoperatively, a significantly higher proportion of patients using VR experienced mild state anxiety (77.8%) and mild trait anxiety (70.8%) compared to control group. Conclusions Immersive VR is a safe and effective non‐pharmacological intervention that significantly reduces intraoperative anxiety and stress while enhancing patient satisfaction during regional anesthesia in this study population. Given its safety profile, efficacy, and favorable economic profile, VR should be considered for integration into standard intraoperative care protocols, though further research is needed to confirm generalizability and cost‐effectiveness. Clinical Trial Registration This study was retrospectively registered at ClinicalTrials.gov with the identifier NCT07132216 on 20 August 2025. The trial protocol is available at https://clinicaltrials.gov/study/NCT07132216?id=NCT07132216&rank=1 .