Evaluation of Pain and Anxiety in Patients With an Invasive Procedure in Emergencies

Evaluation of Pain and Anxiety in Patients With an Invasive Procedure in Emergencies: Randomized Trial

A large number of patients presenting to the emergency department will have an invasive or potentially painful treatment (suture, urinary catheterization, reduction of dislocation or fracture). This care is a source of pain and anxiety for patients.

Since 1998, the management of pain is a public health priority in France. Law No. 2002-3003 of 4 March 2002 on the rights of the sick and the quality of the health system has made pain management a right: "Everyone has the right to receive care to relieve his pain. This must be in all circumstances prevented, evaluated, taken into account and treated ".

In emergency departments, the use of antalgic drug treatments and local anesthetics is systematic.

Other techniques to create diversions proposed in the recommendations of the French Society of Emergency Medicine for the management of wounds in emergencies can be used to improve the experience of patients: the use speech during the gesture or certain forms of hypnosis.

Pain and anxiety are two important factors to integrate to improve the management of patients in emergencies.

To improve pain and anxiety, distraction is a technique that can be used. Virtual reality is a distraction technique not yet frequently used but studied. It combines the visual and the auditory allowing immersion in a virtual world thanks to a helmet retranscribing a three-dimensional image. The diversion of attention through the use of virtual reality allows the patient to immerse themselves in a fictional environment through a mask on the eyes inhibiting the vision of the outside world and a headphone reducing external sounds and reinforcing the mechanism of 'immersion.

The use of the virtual reality headset has already shown benefits during pain care in burn patients and children.

The virtual reality headset has not yet been studied as a distraction tool for invasive and potentially painful care in emergencies.

Inclusion Criteria:

• Man and woman (age ≥ 18 years)
• Francophone
• Patient with medical insurance
• Patient with a wound requiring trunk or limb sutures
• Or male patient requiring an urinary catheter
• Patient with cutaneous and subcutaneous wounds (deep plane possible) but without repair of noble tissues (tendons or fasciae) with no limit on the number of points to be made (i.e. without impact on the main endpoint).

Exclusion Criteria:

• Patient with a wound or skin infection of the face
• Patients with nausea, vomiting, dizziness
• Patients with a history of neurological disorders with epilepsy
• Patient whose investigator judges that he can not wear a virtual reality helmet
• Patient under tutorship or curatorship
• Patient deprived of liberty
• Refusal to participate in the study.