We will investigate whether the use of Virtual Reality (VR) preoperatively and intraoperatively can help treat pain and anxiety, as measured by patient feedback, vital signs trends, and the amounts of anesthetics, pain medications and anxiolytics used during surgical procedures. The VR intervention will be studied during short hand surgeries normally performed using local anesthesia and sedation.

Virtual Reality (VR) is a powerful and inexpensive technology that has been effectively used in healthcare settings to treat anxiety and pain, with minimal side effects. In the last two decades, opioid abuse and deaths related to opioids have increased, and opioid naive patients are at increased risk of opioid abuse when opioids are used during their surgical procedures. In addition, anesthetics, anxiolytics and analgesics, namely opioids, have a myriad of side effects that worsen patient experience, and lead to complications and increased costs. There are limited studies on the use of VR in the perioperative setting. Our study is a randomized controlled trial to investigate the use of VR to treat anxiety and pain in perioperative settings. We will recruit 56 patients, 28 in the control group and 28 in the VR group, undergoing short (<2 hrs) hand or upper extremity surgeries under local anesthesia and monitored anesthesia care (MAC). The control group will receive standard anesthetic management and the VR group will be exposed to VR in the preoperative setting and during the surgical procedure, using the clinically validated AppliedVR software. The data collected will included satisfaction questionnaires and pain scores for anxiety/pain pre- and post- procedure, vital signs trends to assess sympathetic response during surgery, and amount of anesthetics used. We hypothesize that the VR group will show decreased anxiety and pain, increased satisfaction, and decreased use of anesthetics during the procedure.

Inclusion Criteria:

1. 18 years old or older and less or equal to 75 years old.
2. ASA physical status I-II.
3. English speaking.
4. Undergoing elective surgery with local anesthetic with sedation.
5. Surgical time less than 2 hours.

Exclusion Criteria:

1. ASA physical status III or above.
2. Allergy to fentanyl, midazolam or propofol.
3. History of seizure, migraines.
4. Chronic Pain Syndrome.
5. Use of high dose opioids or long acting opioids.
6. Severe anxiety, on daily anxiolytics.
7. Psychiatric comorbidities that preclude the use of VR.
8. Physical disabilities that preclude the use of VR technology in a comfortable manner.
9. Patient refusal.