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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
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.
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).
Time frame: 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.
Time frame: 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.
Time frame: 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.
Time frame: 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.
Time frame: Intraoperative score measured in the immediate postoperative period (<1 day)
Intraoperative Heart Rate
Mid-procedure heart rate measured in beats per minute
Time frame: Intraoperative (<1 day)
Intraoperative Blood Pressure
Mid-procedure systolic and diastolic blood pressure measured in millimetres of mercury
Time frame: Intraoperative (<1 day)
Additional Intraoperative Anaesthetic Doses
The type, dose and concentration of any additional doses of local anaesthesia given to the patient intraoperatively
Time frame: Intraoperative (<1 day)
Additional Intraoperative Sedative Doses
The type, dose and concentration of any (additional) doses of sedative medication given to the patient intraoperatively
Time frame: 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.
Time frame: 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.
Time frame: 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.
Time frame: Intraoperative score measured in the immediate postoperative period (<1 day)
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