Photo Credit: Vzmaze

A five-minute virtual reality intervention reduced chest tube removal pain in patients who underwent coronary artery bypass grafting.

Virtual reality can help ease the pain of chest tube removal (CTR) for patients undergoing coronary artery bypass grafting (CABG), researchers in Iran report.

“The application of VR distraction techniques can be effective in reducing the intensity of pain caused by CTR in patients undergoing CABG,” lead study author Zahra Dalir, PhD, and coauthors wrote in Scientific Reports. “This technique can serve as an effective, accessible, and cost-efficient non-pharmacological approach for managing pain in these patients.”

For the study, Dr. Dalir and colleagues enrolled 70 patients undergoing CABG at two hospitals in Mashhad, Iran, in 2020 and randomized them into two groups of 35. Participants were well matched in both groups, averaging early- to mid-fifties in age and predominantly male (~70%).

Both groups reported similar levels of anxiety and stress, fatigue, and pain before CTR as measured by the Depression Anxiety and Stress Scale-21 (DASS-21), the Rhoten Fatigue Scale (RFS), and the Visual Analogue Scale (VAS), respectively. In about 75% of patients, the chest tube was inserted in the pericardium, and in about 25%, the site was the mediastinum.

Dr. Dalir and colleagues used VAS to measure pain intensity. After researchers recorded the intervention group’s baseline pain intensity, patients put on VR glasses (Shinecon G04BS, China) and watched a 360° natural-landscape video for at least 5 minutes. After the fifth minute, a nurse supervised by a CABG surgeon removed the chest tube. Investigators then stopped the video playback, removed the VR glasses, and recorded pain intensity immediately and 15 minutes after CTR.

By contrast, the study team encouraged patients in the control group to breathe deeply and hold their breath to distract them and reduce lung collapse. Dr. Dalir and colleagues measured their pain intensity using the same scales and time intervals as the intervention group.

The average pain intensity score of patients in the intervention group significantly decreased immediately and 15 minutes after CTR, compared to the control group (P<0.001).

Mann-Whitney test results showed that the difference in the pain intensity scores decreased in the intervention group by 1.5 and increased in the control group by 0.3 immediately after CTR compared with the pre-intervention stage (P<0.001). Also, the difference in pain intensity score decreased by 3.7 in the intervention group and by 2.1 in the control group at 15 minutes after CTR compared with the pre-intervention stage (P<0.001). (Table)

Results Support Wider Adoption

For Aman Mahajan, MD, PhD, MBA, a professor of anesthesiology and perioperative medicine who was not involved in the study, “the results are encouraging, as pharmacological treatments are not always effective in mitigating pain during these procedures.”

“VR in healthcare has seen increased interest recently, and technology has become better, cheaper, and more accessible to clinicians and patients,” says Dr. Mahajan. “This study offers insight into managing acute pain in a commonly performed procedure in a distinct cardiac surgical patient population, further expanding the applicability of VR. VR provides all clinicians with another valuable non-opioid–based pain management approach for patients.”

Dr. Mahajan calls the study well-designed but is interested in the cost-effectiveness of the VR technology, especially when compared with other pain management options. He said it would also be valuable to know how the various types of available VR technologies compare in efficacy.

“VR technology’s benefit has remained limited when it comes to its large-scale adoption for pain relief in clinical practices. There may be several reasons for this, and addressing cost-effectiveness is an important one,” he advises. “Clinicians should consider use of VR-based pain approaches as primary or adjunctive therapies, especially when they want to avoid or reduce opioid use in their patients.”