Perioperative virtual reality for pain and anxiety in adult hand and wrist surgery: a systematic review.

Authors

Shivam Bhindi, Thanmay Mangala Sachidananda, Ali Alseneid, Gunjeet Dua

Published in

JPRAS open. Volume 52. Pages 532-542. Epub Sep 12, 2026.

Abstract

Many adult hand and wrist procedures are performed with the patient awake under local or regional anaesthesia, including wide-awake techniques, a setting in which perioperative anxiety is a salient patient-experience outcome and discomfort may persist despite adequate anaesthesia. Virtual reality has been proposed as a non-pharmacological comfort adjunct, but its effects are procedure-dependent and existing trials come largely from other settings; the high volume of awake hand and wrist surgery, where patients are conscious during anaesthetic administration and manipulation, makes procedure-specific evidence necessary, and none has been synthesised.
MEDLINE (Ovid), Embase and CENTRAL were searched from inception to 19 December 2025 for randomised controlled trials of perioperative virtual reality in adult hand and wrist surgery (PROSPERO CRD420251269092). Selection and extraction were performed in duplicate. Risk of bias was assessed with Cochrane Risk of Bias 2 and certainty with GRADE. Heterogeneity precluded meta-analysis; findings were synthesised narratively.
Seven trials (n = 543; 2019-2025) met inclusion criteria. Virtual reality did not consistently reduce perioperative pain. Of six trials assessing anxiety, three reported significant reductions in intraoperative anxiety during awake procedures; instruments and time points were heterogeneous, and the wide-awake local anaesthesia no tourniquet trial using a validated multi-item questionnaire showed no significant difference. Two trials reported lower intraoperative sedative requirements in pathways including sedation. Virtual reality was well tolerated, with no serious adverse events and minor self-limiting effects in a minority of participants. Certainty of evidence was low for both primary outcomes.
Virtual reality may reduce intraoperative anxiety in selected patients undergoing awake hand and wrist procedures, but evidence for analgesic benefit is inconsistent. Larger trials using validated anxiety instruments, stratified by baseline anxiety, are needed before routine use can be recommended.

PMID:
42840887
Bibliographic data and abstract were imported from PubMed on 07 Oct 2026.

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