Evaluation of Virtual Reality for Reducing Opioid Use After Cardiac and Thoracic Surgery

Postoperative pain management in major cardiac and thoracic surgeries remains a significant clinical challenge due to the side-effect profile of opioids, including respiratory depression and dependency. This study explores Virtual Reality (VR) as a non-pharmacological adjunct based on the gate control theory and the concept of immersive distraction. By engaging multiple sensory faculties, VR aims to compete with nociceptive stimuli for limited attentional resources, thereby modulating pain perception and reducing the emotional component of the pain experience.

This clinical trial compares two distinct VR modalities to identify the most effective mechanism for pain modulation in a high-complexity surgical setting. The Interactive VR arm utilizes high-fidelity devices to engage patients in tasks requiring motor coordination and active cognitive processing, such as interactive gaming. This level of engagement is hypothesized to induce a deeper state of presence. The Passive VR arm focuses on contemplative, 360-degree immersive environments designed to induce physiological relaxation and calmness through visual immersion in tranquil natural settings.

The intervention protocol is standardized to begin on the first postoperative day at the Heart Institute (InCor). Each session is supervised by the research team to ensure proper equipment usage and to monitor for potential adverse effects, such as cybersickness or spatial disorientation. By comparing these immersive levels against a control group receiving standard institutional care, the study seeks to quantify the opioid-sparing effect of digital therapeutics. Statistical analysis will utilize multivariate models to identify associations between VR exposure and improved recovery indicators, providing evidence for the integration of VR into multimodal analgesia strategies.

Inclusion criteria

• Patients undergoing elective cardiac or thoracic surgeries at the Heart Institute (InCor) of the Hospital das Clínicas of the University of São Paulo.
• Eligible thoracic surgeries include: pulmonary decortication, thoracic sympathectomy, video-assisted thoracoscopic surgery (VATS), pulmonary biopsy, and pectus excavatum repair using the Nuss procedure.
• Patients aged between 16 and 40 years.
• Preserved cognitive function, indicated by a Mini-Mental State Examination (MMSE) score of ≥ 25.

Exclusion criteria

• Visual impairments.
• Cognitive impairment (MMSE ≤ 24).
• Severe upper limb motor limitations.
• Claustrophobia.
• Spatial disorientation.
• Motion sickness or vestibular disorders.
• Infectious or contagious diseases.