Not provided
Not provided
Not provided
Not provided
Not provided
Researchers left institution
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
The vast majority of hand surgery performed at the Royal London Hospital is carried out with patients wide-awake. This is either using local or regional (brachial block) anaesthesia. A high proportion of patients find the process stressful and intimidating, which can lead to intraoperative anxiety and increased requirements for anaesthetic dosages. Most of the hand surgery lists are primarily performed by trainees under consultant supervision: conscious, aware, and anxious patients can hinder the degree of training that can take place intra-operatively. Trainees requesting for assistance can further contribute to patient anxiety levels. Virtual Reality (VR) is a relatively new technology that allows total immersion in audio-visual entertainment. Early research work has demonstrated a positive effect of VR at reducing patient anxiety and analgesia requirements during invasive procedures. The investigators hope to conduct a research study whereby adult patients undergoing wide-awake hand surgery under the care of the Department of Plastic Surgery at the Royal London Hospital are given a VR headset (the Oculus Quest 2) and headphones to wear during their operation. The investigators aim to compare their levels of perceived pain, discomfort, anxiety, relaxation and satisfaction with the intraoperative experience to patients who undergo the same operation without VR, i.e. under the conditions of standard care. The investigators will also look at the patients' additional anaesthetic requirements during the operation and physiological markers of anxiety, like heart rate and blood pressure. The operating surgeon will be given the opportunity to answer questions regarding their levels of comfort performing the operation, communicating with their assistant surgeon and calling for help if required. The investigators believe the use of VR will have a positive effect on the patient experience and will improve training opportunities for junior surgeons.
Not provided
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| WITH Virtual Reality headset + headphones | Experimental | Participants in the VR arm will undergo wide-awake hand surgery while using an Oculus Quest 2 Virtual Reality headset and Beats Ep Wired On-Ear headphones for the duration of the operation, as an adjunct to standard local or regional anaesthesia. |
|
| WITHOUT Virtual Reality headset + headphones | No Intervention | Participants in the non-VR arm will undergo wide-awake hand surgery under the conditions of routine intraoperative care, that is under local or regional anaesthesia without any adjuncts, such as the Virtual Reality headset, headphones, or any other form of distraction or relaxation strategy. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Virtual Reality headset + headphones | Device | The intervention involves patient use of a Virtual Reality headset (the Oculus Quest 2) and headphones (Beats Ep Wired On-Ear) during their wide-awake hand operation. |
| Measure | Description | Time Frame |
|---|---|---|
| Patient-reported Pain Score | This will be measured by asking participants to rate their level of intraoperative pain along a 100-mm long visual analogue scale (0 - 100). | Intraoperative score measured in the immediate postoperative period (<1 day) |
| Patient-reported Discomfort Score | This will be measured by asking participants to rate their level of intraoperative discomfort along a 100-mm long visual analogue scale. | Intraoperative score measured in the immediate postoperative period (<1 day) |
| Patient-reported Anxiety Score | This will be measured by asking participants to rate their level of intraoperative anxiety along a 100-mm long visual analogue scale. | Intraoperative score measured in the immediate postoperative period (<1 day) |
| Patient-reported Relaxation Score | This will be measured by asking participants to rate their level of intraoperative relaxation along a 100-mm long visual analogue scale. | Intraoperative score measured in the immediate postoperative period (<1 day) |
| Patient-reported Satisfaction Score | This will be measured by asking participants to rate their level of overall satisfaction with their intraoperative experience along a 100-mm long visual analogue scale. | Intraoperative score measured in the immediate postoperative period (<1 day) |
| Measure | Description | Time Frame |
|---|---|---|
| Intraoperative Heart Rate | Mid-procedure heart rate measured in beats per minute | Intraoperative (<1 day) |
| Intraoperative Blood Pressure | Mid-procedure systolic and diastolic blood pressure measured in millimetres of mercury |
Not provided
Inclusion Criteria:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
No identifiable personal patient data will be shared with other researchers.
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
|
| Intraoperative (<1 day) |
| Additional Intraoperative Anaesthetic Doses | The type, dose and concentration of any additional doses of local anaesthesia given to the patient intraoperatively | Intraoperative (<1 day) |
| Additional Intraoperative Sedative Doses | The type, dose and concentration of any (additional) doses of sedative medication given to the patient intraoperatively | Intraoperative (<1 day) |
| Surgeon-reported Level of Comfort Performing the Operation | This will be measured by asking the operating surgeon to rate their level of comfort performing the operation along a 100-mm long visual analogue scale. | Intraoperative score measured in the immediate postoperative period (<1 day) |
| Surgeon-reported Level of Comfort Communicating with Assistant Surgeon | This will be measured by asking the operating surgeon to rate their level of comfort communicating with their assistant surgeon along a 100-mm long visual analogue scale. | Intraoperative score measured in the immediate postoperative period (<1 day) |
| Surgeon-reported Level of Comfort Calling for Help | This will be measured by asking the operating surgeon to rate their level of comfort calling for help from a more senior surgeon along a 100-mm long visual analogue scale. | Intraoperative score measured in the immediate postoperative period (<1 day) |