The Efficacy of using Virtual Reality for peri-operative anxiety during regional anaesthesia: A non-inferiority randomised controlled trial

(1) Baseline demographics At the point of recruitment, the following demographic data for each patient will be collected: age, gender, type of surgery, and pre-operative Amsterdam pre-operative anxiety and information scale (APAIS). (2) VR Group procedures The patient is brought into the anaesthetic bay as per normal. The VR head-mounted display system used in this study is the Meta Quest 2 unit. It is a standalone unit (no accompanying personal computer required) which minimises issues with cables and another device. It will be preloaded with Nature Treks VR, a program designed specifically for the Meta Quest headset and allows the user to choose from 9 different nature environments (tropical island, underwater, safari, outer space etc). A researcher will introduce the patient to the headset, adjust the straps for comfort, and allow the patient to choose their favourite nature environment for maximum distraction. The headset will be placed on the patient prior to intravenous cannulation and continues throughout the cannulation procedure. After intravenous access has been secured, the VR headset is removed and the patient will repeat the APAIS. Similarly, the VR headset is placed back on the patient prior to the nerve block and the Nature Treks VR program is played throughout the nerve block procedure. After the nerve block is completed, the VR headset is removed and the patient asked to repeat the APAIS. In the VR group, anaesthetists are asked not to provide anxiolytic medications unless the VR is not tolerated and there is a specific patient request for additional medications to help with reducing anxiety and pain from either of these two procedures. If rescue anxiolytic medications were required, this will be noted in the case reporting form. After checking that the nerve block is effective for surgical anaesthesia, the patient is moved from the anaesthetic bay into the operating theatre for their hand surgery. Management of the patient during their surgery is pragmatic and anaesthetists and surgeons are able to continue management as usual of the patient. (3) Intravenous cannulation procedure Site and size of the intravenous cannula is at the discretion of the treating anaesthetist (4) Nerve block procedure Site and type of nerve block is at the discretion of the treating anaesthetist, and would vary depending on clinical indications: type of surgery, predicted duration of surgery, and optimal location of nerve blockade. All anaesthetists would perform these nerve blocks using ultrasound-guidance of the brachial plexus or of peripheral nerves in the forearm. The type of block will be recorded in the case reporting form (5) Surgery and Intra-operative anaesthesia management Surgical and anaesthesia management intra-operatively is pragmatic and is at the discretion of the treating clinical teams