Virtual Reality in Adult Patients Undergoing Neuraxial Anesthesia: A Scoping Review of Perioperative Psychological Outcomes and Patient Experience
Abstract
Background: Patients undergoing neuraxial anesthesia remain conscious during surgery and may experience perioperative anxiety and psychological distress. Virtual reality (VR) has been proposed as a non-pharmacological strategy to improve patient experience. This scoping review aims to map current evidence on VR effects on psychological and experiential outcomes in adults undergoing neuraxial anesthesia.
Methods: This scoping review was conducted in accordance with PRISMA-ScR guidelines. PubMed, Scopus, Web of Science, and Embase were searched up to November 2025. Studies investigating the use of virtual reality among adult patients receiving neuraxial anesthesia in the operating room were included. Information regarding study design, characteristics of the VR intervention, and reported outcomes was collected and summarized narratively.
Results: 13 studies involving 1,127 participants were identified, including 12 randomized controlled trials and one matched retrospective cohort study. Most interventions employed immersive VR during the intraoperative period. Anxiety and stress were the outcomes most frequently assessed, and a large proportion of studies reported significant reductions in anxiety following VR use. Evidence regarding pain reduction was variable and showed limited and inconsistent benefits across studies. Patient satisfaction and comfort were generally improved, whereas findings related to sedative requirements were mixed, with several studies reporting reduced sedative use.
Conclusion: VR appears to be a useful adjunct for enhancing perioperative patient experiences, especially with respect to anxiety reduction and patient satisfaction in adults undergoing neuraxial anesthesia. However, evidence concerning pain outcomes and medication use remains inconclusive, emphasizing the importance of conducting well-designed studies with standardized outcome measures.
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[2] Chiu PL, Li H, Yap KY, Lam KM, Yip PL, Wong CL. Virtual reality–based intervention to reduce preoperative anxiety in adults undergoing elective surgery: a randomized clinical trial. JAMA Netw Open. 2023; 6(10):e2340588.
[3] Tulgar S, Boga I, Piroglu MD, Ates NG, Bombaci E, Can T, et al. Preoperative anxiety before spinal anesthesia: does internet-based visual information/multimedia research decrease anxiety and information desire? A prospective multicentered study. Anesth Essays Res. 2017; 11(2):390-6.
[4] Bello CM, Eisler P, Heidegger T. Perioperative anxiety: current status and future perspectives. J Clin Med. 2025; 14(5):1422.
[5] Ali Z, Ahsan Z, Liaqat N, Din IU. Bridging the gap: evaluation of preoperative patients’ education by comparing expectations and real-perioperative surgical experiences: a mixed-methods descriptive cross-sectional study. BMC Health Serv Res. 2024; 24(1):964.
[6] Li H, Chiu PL, Efendi D, Huang H, Ko KY, Wong CL. Effects of virtual reality–based interventions on preoperative anxiety in patients undergoing elective surgery with anesthesia: systematic review and meta-analysis. J Med Internet Res. 2025; 27:e55291.
[7] Alimonaki EC, Bothou A, Diamanti A, Deltsidou A, Paliatsiou S, Karampas G, et al. Management of preoperative anxiety via virtual reality technology: a systematic review. Nurs Rep. 2025; 15(8):268.
[8] Moharam SA, ElSharkawy MS, ELkashef AM, Romeih MA, El Rasool AO, Shaheen MM. Effect of virtual reality on perioperative anxiety, stress and pain in total hip arthroplasty: a randomized controlled trial. BMC Anesthesiol. 2025; 25(1):446.
[9] Singh N, Kumar Kanaujia S, Singh MK, Shukla N, Siddiqui AK, Kohli M, et al. Effect of virtual reality glasses and melody on cortisol and adrenocorticotropic hormone levels in patients with knee replacement surgery under combined spinal epidural anaesthesia. Cureus. 2024; 16(6):e63017.
[10] Turan AZ, Yilmaz M, Saracoglu T. The effect of virtual reality glasses on anxiety during surgery under spinal anesthesia: a randomized controlled study. Anaesth Pain Intensive Care. 2021; 25(2):170-5.
[11] Arifin J, Mochamat M, Pramadika T, Paramita D, Nurcahyo WI. Effects of immersive virtual reality on patient anxiety during surgery under regional anesthesia: a randomized clinical trial. Anesth Pain Med. 2023; 13(2):e130790.
[12] Moon JY, Shin J, Chung J, Ji SH, Ro S, Kim WH. Virtual reality distraction during endoscopic urologic surgery under spinal anesthesia: a randomized controlled trial. J Clin Med. 2018; 8(1):2.
[13] Asiri S, Currie J, Duff J, Guilhermino M. Effectiveness of virtual reality interventions for perioperative anxiety in adults: a systemic review with meta-analysis. J Clin Nurs. 2025; 34(9):3539-59.
[14] Simonetti V, Tomietto M, Comparcini D, Vankova N, Marcelli S, Cicolini G. Effectiveness of virtual reality in the management of paediatric anxiety during the peri-operative period: a systematic review and meta-analysis. Int J Nurs Stud. 2022; 125:104115.
[15] Boyce L, Jordan C, Egan T, Sivaprakasam R. Can virtual reality enhance the patient experience during awake invasive procedures? A systematic review of randomized controlled trials. Pain. 2024; 165(4):741-52.
[16] Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169(7):467-73.
[17] İnce M, Karaman Özlü Z. The effect of virtual reality on pain, anxiety, physiological parameters, and postspinal headache in patients undergoing spinal anesthesia: a randomized controlled trial. J Perianesth Nurs. 2025; 40(3):604-11.
[18] Sahin G, Basak T. The effects of intraoperative progressive muscle relaxation and virtual reality application on anxiety, vital signs, and satisfaction: a randomized controlled trial. J Perianesth Nurs. 2020; 35(3):269-76.
[19] Jain A, Shilpa HL, Ananda K, Kumar PB. A study of the role of immersive virtual reality on alleviation of patient anxiety during elective haemorrhoidectomy under regional anaesthesia: a randomized clinical trial. Int J Med Public Health. 2025; 15(3):821-8.
[20] Barry KS, Nimma SR, Spaulding AC, Wilke BK, Torp KD, Ledford CK. Perioperative outcomes of immersive virtual reality as adjunct anesthesia in primary total hip and knee arthroplasty. Arthroplast Today. 2022; 18:84-8.
[21] Xu Y, Shou Y, Li Y, Chen D, Wen Y, Huang X, et al. Virtual reality treatment could reduce anxiety for women undergoing cesarean section with spinal anesthesia: a randomized controlled trial. Arch Gynecol Obstet. 2024; 310(3):1509-16.
[22] Carella M, Beck F, Quoilin C, Azongmo MM, Loheac A, Bonhomme VL, et al. Effect of virtual reality hypnosis on intraoperative sedation needs and functional recovery in knee arthroplasty: a prospective randomized clinical trial. Reg Anesth Pain Med. 2025; 50(5):383-9.
[23] Almedhesh SA, Elgzar WT, Ibrahim HA, Osman HA. The effect of virtual reality on anxiety, stress, and hemodynamic parameters during cesarean section: a randomized controlled clinical trial. Saudi Med J. 2022; 43(4):360-9.
[24] Huang MY, Scharf S, Chan PY. Effects of immersive virtual reality therapy on intravenous patient-controlled sedation during orthopaedic surgery under regional anesthesia: a randomized controlled trial. PLoS One. 2020; 15(2):e0229320.
[25] Agüero-Millan B, Abajas-Bustillo R, Ortego-Maté C. Efficacy of nonpharmacologic interventions in preoperative anxiety: a systematic review of systematic reviews. J Clin Nurs. 2023; 32(17-18):6229-42.
[26] Rousseaux F, Faymonville ME, Nyssen AS, Dardenne N, Ledoux D, Massion PB, et al. Can hypnosis and virtual reality reduce anxiety, pain and fatigue among patients who undergo cardiac surgery: a randomised controlled trial. Trials. 2020; 21(1):330.
[27] Theingi S, Leopold I, Ola T, Cohen GS, Maresky HS. Virtual reality as a non-pharmacological adjunct to reduce the use of analgesics in hospitals. J Cogn Enhanc. 2022; 6(1):108-13.
[28] Abbasnia F, Aghebati N, Miri HH, Etezadpour M. Effects of patient education and distraction approaches using virtual reality on pre-operative anxiety and post-operative pain in patients undergoing laparoscopic cholecystectomy. Pain Manag Nurs. 2023; 24(1):54-61.
[29] Girishan Prabhu V, Stanley L, Morgan R, Shirley B. Designing and developing a nature-based virtual reality with heart rate variability biofeedback for surgical anxiety and pain management: evidence from total knee arthroplasty patients. Aging Ment Health. 2024; 28(5):738-53.
[30] Robertson A, Khan R, Fick D, Robertson WB, Gunaratne DR, Yapa S, et al. The effect of virtual reality in reducing preoperative anxiety in patients prior to arthroscopic knee surgery: a randomised controlled trial. In: 2017 IEEE 5th International Conference on Serious Games and Applications for Health (SeGAH); 2017; 1-7.
[31] Li J, Yang H, Xiao Y, Liu X, Ma B, Ma K, et al. The analgesic effects and neural oscillatory mechanisms of virtual reality scenes based on distraction and mindfulness strategies in human volunteers. Br J Anaesth. 2023; 131(6):1082-92.
[32] Weinstein EJ, Levene JL, Cohen MS, Andreae DA, Chao JY, Johnson M, et al. Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. Cochrane Database Syst Rev. 2018; 4:CD007105.
[33] Nijs K, Treunen T, Jalil H, Lensen M, Wintmolders H, Keunen B, et al. Effect of virtual reality (VR) therapy on pain sensation in patients undergoing hand surgery under ultrasound-guided regional anesthesia: a randomized controlled trial. Reg Anesth Pain Med. 2025; rapm-2025-106418.
[34] Esteban-Sopeña J, Beltran-Alacreu H, Terradas-Monllor M, Avendaño-Coy J, García-Magro N. Effectiveness of virtual reality on postoperative pain, disability and range of movement after knee replacement: a systematic review and meta-analysis. Life (Basel). 2024; 14(3):289.
[35] Ding L, Hua H, Zhu H, Zhu S, Lu J, Zhao K, et al. Effects of virtual reality on relieving postoperative pain in surgical patients: a systematic review and meta-analysis. Int J Surg. 2020; 82:87-94.
[36] Mansor K, Abdellatif SA, Mohamed NA. Virtual reality for reducing intraoperative anxiety and improving patient satisfaction under regional anesthesia among palestinian patients: a randomized controlled trial. BMC Anesthesiol. 2025; 25(1):593.
[37] Zako J, Daccache N, Morisson L, Richebé P, Laferrière-Langlois P. Virtual reality for reduction of intraprocedural pharmacological sedation and analgesia in adult patients: a systematic review and meta-analysis. Anaesth Crit Care Pain Med. 2025; 44(2):101483.
[2] Chiu PL, Li H, Yap KY, Lam KM, Yip PL, Wong CL. Virtual reality–based intervention to reduce preoperative anxiety in adults undergoing elective surgery: a randomized clinical trial. JAMA Netw Open. 2023; 6(10):e2340588.
[3] Tulgar S, Boga I, Piroglu MD, Ates NG, Bombaci E, Can T, et al. Preoperative anxiety before spinal anesthesia: does internet-based visual information/multimedia research decrease anxiety and information desire? A prospective multicentered study. Anesth Essays Res. 2017; 11(2):390-6.
[4] Bello CM, Eisler P, Heidegger T. Perioperative anxiety: current status and future perspectives. J Clin Med. 2025; 14(5):1422.
[5] Ali Z, Ahsan Z, Liaqat N, Din IU. Bridging the gap: evaluation of preoperative patients’ education by comparing expectations and real-perioperative surgical experiences: a mixed-methods descriptive cross-sectional study. BMC Health Serv Res. 2024; 24(1):964.
[6] Li H, Chiu PL, Efendi D, Huang H, Ko KY, Wong CL. Effects of virtual reality–based interventions on preoperative anxiety in patients undergoing elective surgery with anesthesia: systematic review and meta-analysis. J Med Internet Res. 2025; 27:e55291.
[7] Alimonaki EC, Bothou A, Diamanti A, Deltsidou A, Paliatsiou S, Karampas G, et al. Management of preoperative anxiety via virtual reality technology: a systematic review. Nurs Rep. 2025; 15(8):268.
[8] Moharam SA, ElSharkawy MS, ELkashef AM, Romeih MA, El Rasool AO, Shaheen MM. Effect of virtual reality on perioperative anxiety, stress and pain in total hip arthroplasty: a randomized controlled trial. BMC Anesthesiol. 2025; 25(1):446.
[9] Singh N, Kumar Kanaujia S, Singh MK, Shukla N, Siddiqui AK, Kohli M, et al. Effect of virtual reality glasses and melody on cortisol and adrenocorticotropic hormone levels in patients with knee replacement surgery under combined spinal epidural anaesthesia. Cureus. 2024; 16(6):e63017.
[10] Turan AZ, Yilmaz M, Saracoglu T. The effect of virtual reality glasses on anxiety during surgery under spinal anesthesia: a randomized controlled study. Anaesth Pain Intensive Care. 2021; 25(2):170-5.
[11] Arifin J, Mochamat M, Pramadika T, Paramita D, Nurcahyo WI. Effects of immersive virtual reality on patient anxiety during surgery under regional anesthesia: a randomized clinical trial. Anesth Pain Med. 2023; 13(2):e130790.
[12] Moon JY, Shin J, Chung J, Ji SH, Ro S, Kim WH. Virtual reality distraction during endoscopic urologic surgery under spinal anesthesia: a randomized controlled trial. J Clin Med. 2018; 8(1):2.
[13] Asiri S, Currie J, Duff J, Guilhermino M. Effectiveness of virtual reality interventions for perioperative anxiety in adults: a systemic review with meta-analysis. J Clin Nurs. 2025; 34(9):3539-59.
[14] Simonetti V, Tomietto M, Comparcini D, Vankova N, Marcelli S, Cicolini G. Effectiveness of virtual reality in the management of paediatric anxiety during the peri-operative period: a systematic review and meta-analysis. Int J Nurs Stud. 2022; 125:104115.
[15] Boyce L, Jordan C, Egan T, Sivaprakasam R. Can virtual reality enhance the patient experience during awake invasive procedures? A systematic review of randomized controlled trials. Pain. 2024; 165(4):741-52.
[16] Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169(7):467-73.
[17] İnce M, Karaman Özlü Z. The effect of virtual reality on pain, anxiety, physiological parameters, and postspinal headache in patients undergoing spinal anesthesia: a randomized controlled trial. J Perianesth Nurs. 2025; 40(3):604-11.
[18] Sahin G, Basak T. The effects of intraoperative progressive muscle relaxation and virtual reality application on anxiety, vital signs, and satisfaction: a randomized controlled trial. J Perianesth Nurs. 2020; 35(3):269-76.
[19] Jain A, Shilpa HL, Ananda K, Kumar PB. A study of the role of immersive virtual reality on alleviation of patient anxiety during elective haemorrhoidectomy under regional anaesthesia: a randomized clinical trial. Int J Med Public Health. 2025; 15(3):821-8.
[20] Barry KS, Nimma SR, Spaulding AC, Wilke BK, Torp KD, Ledford CK. Perioperative outcomes of immersive virtual reality as adjunct anesthesia in primary total hip and knee arthroplasty. Arthroplast Today. 2022; 18:84-8.
[21] Xu Y, Shou Y, Li Y, Chen D, Wen Y, Huang X, et al. Virtual reality treatment could reduce anxiety for women undergoing cesarean section with spinal anesthesia: a randomized controlled trial. Arch Gynecol Obstet. 2024; 310(3):1509-16.
[22] Carella M, Beck F, Quoilin C, Azongmo MM, Loheac A, Bonhomme VL, et al. Effect of virtual reality hypnosis on intraoperative sedation needs and functional recovery in knee arthroplasty: a prospective randomized clinical trial. Reg Anesth Pain Med. 2025; 50(5):383-9.
[23] Almedhesh SA, Elgzar WT, Ibrahim HA, Osman HA. The effect of virtual reality on anxiety, stress, and hemodynamic parameters during cesarean section: a randomized controlled clinical trial. Saudi Med J. 2022; 43(4):360-9.
[24] Huang MY, Scharf S, Chan PY. Effects of immersive virtual reality therapy on intravenous patient-controlled sedation during orthopaedic surgery under regional anesthesia: a randomized controlled trial. PLoS One. 2020; 15(2):e0229320.
[25] Agüero-Millan B, Abajas-Bustillo R, Ortego-Maté C. Efficacy of nonpharmacologic interventions in preoperative anxiety: a systematic review of systematic reviews. J Clin Nurs. 2023; 32(17-18):6229-42.
[26] Rousseaux F, Faymonville ME, Nyssen AS, Dardenne N, Ledoux D, Massion PB, et al. Can hypnosis and virtual reality reduce anxiety, pain and fatigue among patients who undergo cardiac surgery: a randomised controlled trial. Trials. 2020; 21(1):330.
[27] Theingi S, Leopold I, Ola T, Cohen GS, Maresky HS. Virtual reality as a non-pharmacological adjunct to reduce the use of analgesics in hospitals. J Cogn Enhanc. 2022; 6(1):108-13.
[28] Abbasnia F, Aghebati N, Miri HH, Etezadpour M. Effects of patient education and distraction approaches using virtual reality on pre-operative anxiety and post-operative pain in patients undergoing laparoscopic cholecystectomy. Pain Manag Nurs. 2023; 24(1):54-61.
[29] Girishan Prabhu V, Stanley L, Morgan R, Shirley B. Designing and developing a nature-based virtual reality with heart rate variability biofeedback for surgical anxiety and pain management: evidence from total knee arthroplasty patients. Aging Ment Health. 2024; 28(5):738-53.
[30] Robertson A, Khan R, Fick D, Robertson WB, Gunaratne DR, Yapa S, et al. The effect of virtual reality in reducing preoperative anxiety in patients prior to arthroscopic knee surgery: a randomised controlled trial. In: 2017 IEEE 5th International Conference on Serious Games and Applications for Health (SeGAH); 2017; 1-7.
[31] Li J, Yang H, Xiao Y, Liu X, Ma B, Ma K, et al. The analgesic effects and neural oscillatory mechanisms of virtual reality scenes based on distraction and mindfulness strategies in human volunteers. Br J Anaesth. 2023; 131(6):1082-92.
[32] Weinstein EJ, Levene JL, Cohen MS, Andreae DA, Chao JY, Johnson M, et al. Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. Cochrane Database Syst Rev. 2018; 4:CD007105.
[33] Nijs K, Treunen T, Jalil H, Lensen M, Wintmolders H, Keunen B, et al. Effect of virtual reality (VR) therapy on pain sensation in patients undergoing hand surgery under ultrasound-guided regional anesthesia: a randomized controlled trial. Reg Anesth Pain Med. 2025; rapm-2025-106418.
[34] Esteban-Sopeña J, Beltran-Alacreu H, Terradas-Monllor M, Avendaño-Coy J, García-Magro N. Effectiveness of virtual reality on postoperative pain, disability and range of movement after knee replacement: a systematic review and meta-analysis. Life (Basel). 2024; 14(3):289.
[35] Ding L, Hua H, Zhu H, Zhu S, Lu J, Zhao K, et al. Effects of virtual reality on relieving postoperative pain in surgical patients: a systematic review and meta-analysis. Int J Surg. 2020; 82:87-94.
[36] Mansor K, Abdellatif SA, Mohamed NA. Virtual reality for reducing intraoperative anxiety and improving patient satisfaction under regional anesthesia among palestinian patients: a randomized controlled trial. BMC Anesthesiol. 2025; 25(1):593.
[37] Zako J, Daccache N, Morisson L, Richebé P, Laferrière-Langlois P. Virtual reality for reduction of intraprocedural pharmacological sedation and analgesia in adult patients: a systematic review and meta-analysis. Anaesth Crit Care Pain Med. 2025; 44(2):101483.
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How to Cite
1.
Khonakdar K, Shirzad M, Bakhtiari R, Jahromi A, Rostamian T. Virtual Reality in Adult Patients Undergoing Neuraxial Anesthesia: A Scoping Review of Perioperative Psychological Outcomes and Patient Experience. Arch Anesth & Crit Care. 2026;.
