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Biophilic virtual reality on children’s anxiety and pain during circumcision: A randomized controlled study

  • Wenjun Luo
    Affiliations
    School of Medicine, Ningbo University, Ningbo, Zhejiang, China

    Department of Anesthesia, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
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  • Chunqu Chen
    Affiliations
    School of Medicine, Ningbo University, Ningbo, Zhejiang, China

    Department of Radiology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
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  • Weijian Zhou
    Affiliations
    School of Medicine, Ningbo University, Ningbo, Zhejiang, China

    Department of Radiology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
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  • Angyang Cao
    Affiliations
    School of Medicine, Ningbo University, Ningbo, Zhejiang, China

    Department of Anesthesia, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
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  • Weichao Zhu
    Affiliations
    Department of Pediatric Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
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  • Yanling Zhou
    Affiliations
    School of Medicine, Ningbo University, Ningbo, Zhejiang, China

    Department of Anesthesia, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
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  • Zhipeng Xu
    Affiliations
    Department of Anesthesia, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
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  • Jianhua Wang
    Affiliations
    Department of Radiology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
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  • Binbin Zhu
    Correspondence
    Correspondence to: Binbin Zhu, Department of Anesthesia, The Affiliated Hospital of Medical School of Ningbo University; No. 247, Renmin Road, Jiangbei District, Ningbo City, Zhejiang Province, China, Tel.: +86 15957485723
    Affiliations
    Department of Anesthesia, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
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Published:October 19, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.10.023

      Summary

      Introduction

      The aim of this study was to evaluate the effects of the biophilic virtual reality (BVR) method on children's pain and anxiety undergoing circumcision.

      Materials and methods

      This randomized controlled study used a parallel trial design guided by the CONSORT checklist. A total of 106 children were included in the analysis. Intraoperative anxiety was assessed by using the simplified Chinese version of the modified Yale Preoperative Anxiety Scale (CmYPAS), Visual Analogue Scale (VAS), heart rate (HR), and Anxiety index (Ai). Intraoperative pain was assessed by using the Faces Pain Scale-Revised (FPS-R), and Pain index (Pi). The Pearson correlation analysis was used to analyze the relationship between Ai and the CmYPAS. The primary outcomes were CmYPAS, VAS, and FPS-R, which were analyzed using the Kruskal-Wallis test.

      Results

      Baseline variables were not significantly different between the BVR group (34 patients), the indoor virtual reality (IVR) group (36 patients), and the blank control group (36 patients). The CmYPAS scores during surgery were significantly lower in the BVR group and the IVR group versus the blank control group (25.0[22.9–29.2], 22.9[22.9–29.2], 33.3[33.3–38.5] respectively; P < 0.001). The VAS scores during surgery were significantly lower in the BVR group and the IVR group versus the blank control group (5.0[3.0–7.0], 3.0[2.0–5.0], 6.0[5.0–8.8] respectively; P < 0.001). The FPS-R scores during surgery were significantly lower in the BVR group and IVR group versus the blank control group (2.0[1.8–4.2], 3.0[2.0–4.8], 5.5[5.0–8.0], respectively; P < 0.001). At removal of the foreskin, Pi were significantly lower in the BVR group and IVR group versus the blank control group (6.9[4.1], 7.7[3.3], 9.8[6.2] respectively; P = 0.033). The Ai scores at each time point were significantly lower in the BVR group and IVR group versus the control (P = 0.015, P = 0.006 respectively). The correlation analysis of Ai (at removal of the foreskin) and CmYPAS scores in children showed that the Pearson correlation coefficient was 0.194 (P = 0.046).

      Discussion

      This is the first RCT to investigate the effects of BVR in children undergoing circumcision. This study demonstrates a reduction in pediatric intraoperative pain and anxiety with the use of virtual reality (VR).

      Conclusion

      Summary Figure

      Keywords

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