A randomized control trial for assessing virtual reality for perioperative anxiolysis and postoperative pain modulation in adolescents undergoing MIRPE

J Pediatr Surg. 2026 Feb 26:163042. doi: 10.1016/j.jpedsurg.2026.163042. Online ahead of print.

ABSTRACT

BACKGROUND: Pectus deformities, including pectus excavatum, are associated with psychosocial burden and in severe cases impaired cardiorespiratory function. Minimally invasive repair of pectus excavatum (MIRPE) is the standard corrective surgery; however, the postoperative pain can be significant. Patients' perioperative anxiety can be severe as they are cognitively aware of the awaiting surgical challenges but often lack effective coping strategies. Virtual reality (VR) is a non-invasive, non-pharmacological modality that has shown promise in reducing anxiety and modulate pain in the pediatric population. This study aimed to evaluate the effect of VR as a distraction tool in decreasing anxiety and pain associated with MIRPE.

METHODS: In this single-center, randomized-controlled study, 50 patients aged 13-18 were enrolled in 2022-2024. Patients were scheduled for elective surgery with general anesthesia and were randomly allocated to VR (n=25) or control (n=25) group. State-Trait Anxiety Inventory (STAI) tests were recorded upon admission to the hospital, on arrival at the operating room and in the morning after the surgery, complemented with emergence delirium and pain assessment tests, when appropriate. All patients received midazolam as premedication. Patients assigned to the VR group received a VR headset and underwent audiovisual distraction for an hour before the surgery. The main outcome was the STAI-S score in the operating room. Data is in median [IQR].

RESULTS: Median patient age was 15.6 and 82% were male. No difference was found between the STAI-S scores between the two groups on admission (37 [32.5, 47] and 41 [35; 47]); in the operating room (39 [32.5, 47] and 42.5 [35; 48.3]); and in the postoperative morning (37 [32, 42] and 39 [35, 45], respectively). Multiple regression revealed that STAI-S at admission and patients' age are significantly associated with anxiety levels in the OR (p= <0.001, p=0.039). Points on the emergence delirium score, and postoperative numerical rating scale for pain were similar in the two groups apart from 1 hour postoperative, which was significantly lower in the VR group (p=0.012).

CONCLUSION: Although VR was proven useful in anxiolysis in previous papers in the pediatric setting, this study could not detect a change in anxiety with the use of VR in the perioperative period of MIRPE in adolescents. It is conceivable that the midazolam administered as premedication neutralized the effect of VR.

CLINICAL TRIAL NUMBER: NCT06446518.

PMID:41763294 | DOI:10.1016/j.jpedsurg.2026.163042