Use of Virtual Reality as a Distraction Technique to Limit Opiate Use in Traumatic and Surgical Wound Dressing Management
Corresponding AuthorAlbert Chi
Division of Trauma, Critical Care & Acute Care Surgery Department of Surgery, Oregon Health and Science University Portland, Oregon, USA
A B S T R A C T
Background: Chronic opiate use in traumatic and surgical wound management has become an increasingly controversial topic nationally. Here we present a case of a large surgical wound previously managed with operative dressing changes with significant opiate use for pain control with the use of virtual reality at the time of dressing changes to decrease opiate use as well as operative need; and therefore, overall cost. Case Presentation: The patient is a 57-year-old female with morbid obesity and poorly controlled diabetes mellitus who presented with a necrotizing soft tissue infection of the left thigh. She was admitted to the intensive care unit, initiated on broad spectrum antibiotics, and taken to the operating room for excisional debridement. After stabilization and source control, the patient continued to require operative incisional wound vac changes every other day despite maximal multimodal pain therapy. After discussion with the patient regarding her continued ongoing operative wound vac changes and her desire to progress care, the team attempted a bedside dressing change utilizing the Facebook Oculus Quest Virtual Reality device application “Nature Treks VR”. The patient endorsed reduced pain scores during the dressing change and endorsed emersion into the virtual world throughout the dressing change. Conclusion: To the best of our knowledge this is the first reported incidence of using a virtual reality platform to reduce opiate use, operative need, progression of care, and overall cost in a patient with a large, debilitating operative wound outside of the burn population. Advances in virtual reality hardware including tether less systems like Oculus Quest, non-controller hand tracking and headset sanitation devices have reduced barriers to introducing virtual reality therapy into the clinic and ICU. A prospective study is needed to validate the use of virtual reality as a distraction therapy at the time of dressing changes. Future use of virtual reality may involve reducing ICU delirium, targeted pain management, post trauma recovery exercises and enhanced rehabilitation of amputees with prosthetic devices.
Article TypeCase Report
Publication historyReceived: Sat 30, May 2020
Accepted: Thu 11, Jun 2020
Published: Wed 24, Jun 2020
Copyright© 2019 Albert Chi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository. All rights reserved.