Advertisement

Effects of Patient Education and Distraction Approaches Using Virtual Reality on Pre-operative Anxiety and Post-operative Pain in Patients Undergoing Laparoscopic Cholecystectomy

Published:January 17, 2023DOI:https://doi.org/10.1016/j.pmn.2022.12.006

      Abstract

      Background

      Fear of post-operative pain often contributes to pre-operative anxiety; accordingly, pain and anxiety are among the most common complications in patients undergoing laparoscopic cholecystectomy (LC).

      Aim

      The present study aimed to determine the effects of patient education and distraction using virtual reality (VR) on pre-operative anxiety and post-operative pain in patients undergoing LC.

      Method

      This randomized clinical trial included 150 patients in the surgery wards of educational hospitals in Mashhad, Iran, in 2020. The participants were randomly assigned to three groups of education, distraction, and control. The education and distraction groups watched two five-minute animations and three 360-degree images of nature using VR glasses 2 hours before and 4 hours after the surgery, respectively. On the other hand, the control group received routine care. Anxiety was measured using Spielberger's State Anxiety Inventory before and half an hour after the intervention. Moreover, the pain was measured using the visual analog scale and McGill Pain Questionnaire.

      Results

      The results demonstrated a significant reduction in the two VR groups regarding the pre-operative anxiety mean scores, compared with the control group (p < .001). Furthermore, a significant reduction was observed in post-operative pain scores of patients in the two intervention groups compared with the control group (p = .001).

      Conclusions

      As evidenced by the results, both VR approaches of patient education and distraction equally decreased pre-operative anxiety and post-operative pain in patients undergoing LC.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Pain Management Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ackley B.J.
        • Ladwig G.B.
        • Makic M.B.F.
        • Martinez-Kratz M.
        • Zanotti M.
        Nursing Diagnosis Handbook, Revised Reprint with 2021-2023 NANDA-I® Updates-E-Book.
        Elsevier Health Sciences, 2021
        • Adib-Hajbaghery M.
        • Zare M.
        The barriers to patient education from the viewpoint of nurses in iran: A systematic review.
        Nursing And Midwifery Journal. 2017; 15: 544-558
        • Alanazi A.A.
        Reducing anxiety in preoperative patients: A systematic review.
        British Journal of Nursing. 2014; 23: 387-393
        • Amini K.
        • Alihossaini Z.
        • Ghahremani Z.
        Randomized clinical trial comparison of the effect of verbal education and education booklet on preoperative anxiety.
        Journal of PeriAnesthesia Nursing. 2019; 34: 289-296
        • Aydemir Ö.
        • Aslan F.E.
        • Karabacak Ü.
        • Akdaş Ö.
        The effect of exaggerated lithotomy position on shoulder pain after laparoscopic cholecystectomy.
        Pain Management Nursing. 2018; 19: 663-670
        • Ayyadhah Alanazi A.
        Reducing anxiety in preoperative patients: a systematic review.
        British Journal of Nursing. 2014; 23: 387-393https://doi.org/10.12968/bjon.2014.23.7.387
        • Bekelis K.
        • Calnan D.
        • Simmons N.
        • MacKenzie T.A.
        • Kakoulides G.
        Effect of an immersive preoperative virtual reality experience on patient reported outcomes: A randomized controlled trial.
        Annals of Surgery. 2017; 265: 1068-1073
        • Binagi S.
        • Keune J.
        • Awad M.
        Immediate postoperative pain: An atypical presentation of dropped gallstones after laparoscopic cholecystectomy.
        Case Reports in Surgery. 2015; 2015930450
        • Campagna S.
        • Antonielli D'Oulx M.D.
        • Paradiso R.
        • Perretta L.
        • Re Viglietti S.
        • Berchialla P.
        • Dimonte V
        Postoperative Pain, an unmet problem in day or overnight Italian surgery patients: A prospective study.
        Pain Research & Management. 2016; (20166104383-6104383)
        • Çankaya A.
        • Saritaş S.
        Effect of classic foot massage on vital signs, pain, and nausea/vomiting symptoms after laparoscopic cholecystectomy.
        Surgical Laparoscopy Endoscopy & Percutananeous Techniques. 2018; 28: 359-365
        • Deal S.B.
        • Stefanidis D.
        • Brunt L.M.
        • Alseidi A.
        Development of a multimedia tutorial to educate how to assess the critical view of safety in laparoscopic cholecystectomy using expert review and crowd-sourcing.
        American Journal of Surgery. 2017; 213: 988-990
        • Dehghan F.
        • Jalali R.
        • Bashiri H.
        The effect of virtual reality technology on preoperative anxiety in children: A Solomon four-group randomized clinical trial.
        Perioperative Medicine. 2019; 8: 1-7
        • Dworkin R.H.
        • Turk D.C.
        • Revicki D.A.
        • Harding G.
        • Coyne K.S.
        • Peirce-Sandner S.
        • Bhagwat D.
        • Everton D.
        • Burke L.B.
        • Cowan P.
        • Farrar J.T.
        • Hertz S.
        • Max M.B.
        • Rappaport B.A.
        • Melzack R.
        Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2).
        Pain. 2009; 144: 35-42
        • Eijlers R.
        • Dierckx B.
        • Staals L.M.
        • Berghmans J.M.
        • van der Schroeff M.P.
        • Strabbing E.M.
        • Wijnen R.M.H.
        • Hillegers M.H.J.
        • Legerstee J.S.
        • Utens E.M.
        Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised controlled trial.
        European Journal of Anaesthesiology. 2019; 36: 728
        • Gan T.J.
        Poorly controlled postoperative pain: prevalence, consequences, and prevention.
        Journal of Pain Research. 2017; 10: 2287
        • Ganry L.
        • Hersant B.
        • Sidahmed-Mezi M.
        • Dhonneur G.
        • Meningaud J.
        Using virtual reality to control preoperative anxiety in ambulatory surgery patients: A pilot study in maxillofacial and plastic surgery.
        Journal of Stomatology, Oral and Maxillofacial Surgery. 2018; 119: 257-261
        • Gershon J.
        • Anderson P.
        • Graap K.
        • Zimand E.
        • Hodges L.
        • Rothbaum B.O.
        Virtual reality Exposure therapy in the treatment of anxiety disorders. The Scientific Review of Mental Health Practice: Objective Investigations of Controversial and Unorthodox Claims in Clinical Psychology.
        Psychiatry, and Social Work. 2002;
        • Graversen M.
        • Sommer T.
        Perioperative music may reduce pain and fatigue in patients undergoing laparoscopic cholecystectomy.
        Acta Anaesthesioloica Scandinavica. 2013; 57: 1010-1016
        • Gustafsson S.
        • Strömqvist M.
        • Ekelund J.
        • Engström Å.
        Factors influencing early postoperative recovery after laparoscopic cholecystectomy.
        Journal of PeriAnesthesia Nursing. 2020; 35: 80-84https://doi.org/10.1016/j.jopan.2019.06.002
        • Hoffman H.G.
        • Patterson D.R.
        • Seibel E.
        • Soltani M.
        • Jewett-Leahy L.
        • Sharar S.R.
        Virtual reality pain control during burn wound debridement in the hydrotank.
        The Clinical Journal of Pain. 2008; 24: 299-304
        • Jlala H.
        • French J.
        • Foxall G.
        • Hardman J.
        • Bedforth N.
        Effect of preoperative multimedia information on perioperative anxiety in patients undergoing procedures under regional anaesthesia.
        British Journal of Anaesthesia. 2010; 104: 369-374
        • Jong M.
        • Pijl A.
        • de Gast H.
        • Sjöling M.
        P02.128. The effects of guided imagery on preoperative anxiety and pain management in patients undergoing Laparoscopic Cholecystectomy in a multi-centre RCT study.
        BMC Complementary and Alternative Medicine. 2012; 12 (P184-P184)
        • Koo C.-H.
        • Park J.-W.
        • Ryu J.-H.
        • Han S.-H.
        The effect of virtual reality on preoperative anxiety: A meta-analysis of randomized controlled trials.
        Journal of Clinical Medicine. 2020; 9: 3151
        • Koraş K.
        • Karabulut N.
        The effect of foot massage on postoperative pain and anxiety levels in laparoscopic cholecystectomy surgery: A randomized controlled experimental study.
        Journal of PeriAnesthesia Nursing. 2019; 34: 551-558
        • Kumar A.
        • Dubey P.K.
        • Ranjan A.
        Assessment of anxiety in surgical patients: An observational study.
        Anesthesia, Essays and Researches. 2019; 13: 503
        • Kuzminskaitė V.
        • Kaklauskaitė J.
        • Petkevičiūtė J.
        Incidence and features of preoperative anxiety in patients undergoing elective non-cardiac surgery.
        Acta Medica Lituanica. 2019; 26: 93
        • Li A.
        • Montaño Z.
        • Chen V.J.
        • Gold J.I.
        Virtual reality and pain management: Current trends and future directions.
        Pain Management. 2011; 1: 147-157
        • Malloy K.M.
        • Milling L.S.
        The effectiveness of virtual reality distraction for pain reduction: A systematic review.
        Clinical Psychology Review. 2010; 30: 1011-1018
        • Mardani Hamuleh M.
        • Shahraki Vahed A.
        • Roozitalab M
        A comparison of the importance of patient educational programs in the viewpoint of nurses and patients.
        Journal of Jahrom University of Medical Sciences. 2010; 8: 49-55
      1. Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1(3), 277-299.

        • Mollahosseini S.
        • Sahbaei F.
        • Ebrahimi E.
        • Sadighi Z.
        Efficacy of thought aversion technique on.
        Medical Science Journal of Islamic Azad Univesity-Tehran Medical Branch. 2007; 17: 223-226
        • Mosso Vázquez J.L.
        • Mosso Lara D.
        • Mosso Lara J.L.
        • Miller I.
        • Wiederhold M.D.
        • Wiederhold B.K
        Pain distraction during ambulatory surgery: Virtual reality and mobile devices.
        Cyberpsychology, Behavior, and Social Networking. 2019; 22: 15-21
        • Panahi-shahri M.
        Spielberger State-Trait test standardization among students in Isfahan.
        Tarbiat-Modares University, Tehran1994 (MA thesis)
        • Patiraki E.
        • Katsaragakis S.
        • Dreliozi A.
        • Prezerakos P.
        Nursing care plans based on NANDA, N ursing I nterventions C lassification, and N ursing O utcomes C lassification: The investigation of the effectiveness of an educational intervention in Greece.
        International Journal of Nursing Knowledge. 2017; 28: 88-93
        • Peate I.
        Pudner's Nursing the Surgical Patient E-Book.
        Elsevier Health Sciences, 2020
        • Persky S.
        Application of virtual reality methods to obesity prevention and management research.
        Journal of Diabetes Science and Technology. 2011; 5: 333-339
        • Piskorz J.
        • Czub M.
        Effectiveness of a virtual reality intervention to minimize pediatric stress and pain intensity during venipuncture.
        Journal for Specialists in Pediatric Nursing. 2018; 23: e12201
        • Pouryousef F.
        • Navidian A.
        • Rafizadeh Ghahdarijani O.
        • Yaghoubinia F.
        Comparing the effect of virtual reality and rhythmic breathing on the anxiety of the patients undergoing coronary angiography.
        The Horizon of Medical Sciences. 2020; 27: 2-17
        • Rezvani Amin M.
        • Siratinayer M.
        • Abadi A.
        • Moradyan T.
        Correlation between visual analogue scale and short form of McGill questionnaire in patients with chronic low back pain.
        Qom University of Medical Sciences Journal. 2011; 5: 31-34
        • Schiza E.
        • Matsangidou M.
        • Neokleous K.
        • Pattichis C.S.
        Virtual reality applications for neurological disease: A review.
        Frontiers in Robotics and AI. 2019; 6
        • Silva M.B.
        • de Melo P.R.
        • de Oliveira N.M.
        • Crema E.
        • Fernandes L.F.
        Analgesic effect of transcutaneous electrical nerve stimulation after laparoscopic cholecystectomy.
        American Journal of Physical Medicine & Rehabilitation. 2012; 91: 652-657
        • Smith V.
        • Warty R.R.
        • Sursas J.A.
        • Payne O.
        • Nair A.
        • Krishnan S.
        • da Silva Costa F.
        • Wallace E.M.
        • Vollenhoven B.
        The effectiveness of virtual reality in managing acute pain and anxiety for medical inpatients: Systematic review.
        Journal of Medical Internet Research. 2020; 22: e17980
        • Spielberger C.
        • Gorsuch R.
        • Lushene R.
        State-trait anxiety inventory STAI (Form Y).
        Redw City Mind Gard. 1983
        • Wakabayashi G.
        • Iwashita Y.
        • Hibi T.
        • Takada T.
        • Strasberg S.M.
        • Asbun H.J.
        • Endo I.
        • Umezawa A.
        • Asai K.
        • Suzuki K.
        • Mori Y.
        • Okamoto K.
        • Pitt H.A.
        • Han H.-S.
        • Hwang T.-L.
        • Yoon Y.-S.
        • Yoon D.-S.
        • Choi I.-S.
        • Huang W.S.-W.
        • Giménez M.E.
        • Garden O.J.
        • Gouma D.J.
        • Belli G.
        • Dervenis C.
        • Jagannath P.
        • Chan A.C.W.
        • Lau W.Y.
        • Liu K.-H.
        • Su C.-H.
        • Misawa T.
        • Nakamura M.
        • Horiguchi A.
        • Tagaya N.
        Tokyo Guidelines 2018: Surgical management of acute cholecystitis: Safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos).
        Journal of Hepato-Biliary-Pancreatic Sciences. 2018; 25: 73-86
        • Xiong W.
        • Li M.
        • Wang M.
        • Zhang S.
        • Yang Q.
        The safety of laparoscopic cholecystectomy in the day surgery unit comparing with that in the inpatient unit: A systematic review and meta-analysis.
        BioMed Researcch International. 2020; 20201924134
        • Zahedian A.
        • Shoja M.
        • Mollazade H.
        • Taiebi M.
        Shoulder pain following laparoscopic: a randomized clinical trial: A brief report.
        Tehran University Medical Journal. 2014; 72
        • Zamani F.
        • Sohrabi M.
        • Alipour A.
        • Motamed N.
        • Saeedian F.S.
        • Pirzad R.
        • Abedi K.
        • Maadi M.
        • Ajdarkosh H.
        • Hemmasi J.
        • Khonsari M.
        Prevalence and risk factors of cholelithiasis in Amol City, Northern Iran: A population based study.
        Archives of Iranian Medicine. 2014; 17 (0-0)