Virtual Reality Therapy and Patient Controlled Sedation in Joint Replacement Surgery

Providing patients with a set of virtual reality goggles, either Samsung Gear VR, or Oculus Rift DK2 goggles playing simulations of floating down scenic outdoor vistas. On the Gear VR this was EdenRiver 1.0 by Unello Design, and on the Oculus Rift DK2 this was Iceland by VergeVR. Intervention lasted to the end of the procedure, or to when the patient self-removed the IVR therapy. This occurred in the operating theatres at St Vincent's Hospital, Melbourne. The principal investigator, Mark Huang, administered the treatment, in conjunction of the list anaesthetist. Adherence was monitored by watching the patient for any discomfort, and any attempts at removal were documented. Sedation administered was the same in the intervention/control arm: Regional anaesthesia for all patients was performed by the Anaesthesiologist. Between 2.8 and 3.4 ml of 0.5% Bupivacaine was injected into the L4-L5 subarachnoid space. For knee replacements, a popliteal nerve block was administered using 20ml of 0.2% ropivicaine and a femoral nerve catheters were inserted, with the patient receiving 20ml of 0.375% ropivicaine. Each patient was given a patient controlled sedation (PCS) button, with each press of the PCS supplying a propofol bolus of 400mcg/kg Ideal Body Weight with a 5 minute lockout period. The anaesthetist was also permitted to give adjuvant fentanyl or midazolam as he/she felt fit.