The Effectiveness of Immersive Virtual Reality as a Pain Control Modality After Hip Arthroscopy

The overall purpose of this prospective matched cohort investigation is to assess the efficacy of postoperative iVR compared to a standard multimodal pain regimen including opioids, on acute postoperative pain management following hip arthroscopy. The goal is to determine whether iVR in the immediate post-operative ambulatory setting would have any effect on subjective pain, anxiety, and nausea scores or on patients' opioid consumption. The primary objective of this study is to evaluate the effects of administering a head-mounted immersive virtual reality (iVR) experience to control postoperative pain and nausea in patients undergoing hip arthroscopy. The secondary objective of this study is to evaluate the effectiveness of specific iVR modules in pain perception and decreasing overall opioid use for post-operative pain control. We will prospectively compare a cohort of primary hip arthroscopy patients who receive postoperative iVR therapy in addition to the standard multimodal pain regimen (including a preoperative local field block) with a matched cohort of hip arthroscopy patients who receive only the standard regimen (including field block) in the acute postoperative ambulatory setting. On the day of surgery, the iVR group will receive a 30-minute sessions or "dose" of iVR therapy in the ambulatory post-anesthesia care unit (PACU) during their stay in addition to the standard postoperative pain protocol (including a pre-operative local field block). The three distraction-based or skills-based iVR modules will consist of either 1) Mindful Escape; 2) Empowered Breathing; or 3) Relaxation videos. The iVR group will be sub-randomized into receiving only one of the three types of modules. The modules will start approximately 30 minutes upon arriving in PACU and will last approximately 30 minutes. Both groups will receive the standard postoperative pain protocol on an as needed basis.

The duration of the study is three weeks (pre-operative visit, operative day, and first post-operative visit).

Patients will be screened and enrolled at their pre-operative visit. Included patients will be consented and will fill out the pre-operative questionnaires in order to provide baseline data. They will be randomized into the control group or the iVR therapy group. On the day of surgery, they will undergo their local field block by their anesthesiologist pre-operatively, undergo their hip arthroscopy procedure as indicated by their surgeon, and undergo their VR therapy in PACU as described above. They will be asked for their pain scores when leaving PACU, and their opioid medication usage during PACU will be recorded. Post-operative questionnaires will also be completed prior to discharge from PACU and at the first post-op visit.

The study involves participation at a single timepoint only. The study procedures to be done are listed below: Virtual Reality Therapy in PACU performed once as described above.

Inclusion criteria

• Patients 18 years of age or older with hip pathology
• Failed non-operative treatment of hip pathology
• Undergoing primary, elective and isolated hip arthroscopy for their hip pathology
• Complete pre-operative and post-operative questionnaires

Exclusion criteria

• Minors (17 years of age and younger)
• Traumatic injuries undergoing emergent surgery
• Undergoing revision hip arthroscopic surgery
• Do not complete pre-operative and post-operative questionnaires
• Patients not able to undergo elective surgery
• Pregnant women
• Prisoners
• Patients with conditions that interfere with VR usage including: history of seizure or epilepsy, facial injury precluding safe placement of headset, visual impairment impacting ability to visualize VR images, hearing impairment impacting ability to follow audio instructions