Cnopf´sche Kinderklinik

BackgroundVirtual reality (VR) technology has gained significant importance in medical practice, particularly as an innovative approach to enhance patient experience and comfort. This prospective feasibility study investigates the impact of using VR headsets on stress and pain reduction during port surgeries under local anesthesia.MethodsIn this prospective analysis, patients undergoing port implantation at the Klinikum rechts der Isar Technical University Munich were divided into two groups. The intervention group wore VR headsets during the surgical procedure, while the control group did not. Various validated questionnaires were used to measure psychological parameters such as pain perception, stress, calmness, and relaxation. The amount of local anesthesia administered was also documented.ResultsThe study results showed that patients in the VR group required significantly less local anesthesia than those in the control group (p = 0.0025). Pain perception in the VR group was significantly lower (p = 0.028). Additionally, self-assessments regarding calmness, relaxation, and satisfaction were significantly improved in the VR group (p < 0.01). A stronger correlation between higher pain catastrophizing scale scores and anesthetic requirements was observed in the VR group, suggesting that VR may offer particular benefits for patients with increased pain sensitivity. Although gender differences were not statistically significant, a trend toward higher anesthetic requirements in male patients was noted. The evaluation of the VR headsets by patients was overwhelmingly positive, indicating high acceptance of the technology.DiscussionThe use of VR headsets during surgical procedures can significantly enhance patient comfort by reducing pain and stress levels. The high patient acceptance and positive evaluations of VR suggest its feasibility for broader clinical application. However, future studies should address potential cognitive biases, compare VR with other distraction methods, and explore its effects on different patient subgroups. Future research should also consider the role of gender-specific factors in the modulation of anesthetic requirements by VR. Additionally, a comprehensive cost–benefit analysis will be crucial for assessing the economic viability of VR technology in healthcare.ConclusionVR technology represents a promising method to improve patient experience and comfort in surgical settings. The positive outcomes of this study encourage further research to fully capture and validate the potential of VR in medicine, particularly in pain management and stress reduction during various medical procedures.

Existing therapies for neurogenic detrusor overactivity (NDO), i.e. oral anticholinergics and botulinum toxin injections, can be associated with serious adverse effects or are not always sufficiently effective. Therefore, there is aneed for alternative safe and effective treatment options for NDO. Intravesical oxybutynin has been successfully used for several years as a prescription drug in adults and children with spinal cord injury and spina bifida. In 2019, VESOXX® (FARCO-PHARMA, Cologne, Germany) became the first registered intravesical oxybutynin product in Germany, which is indicated for the suppression of neurogenic detrusor overactivity (NDO) in children from 6years of age and adults, who are managing bladder emptying by clean intermittent catheterisation (CIC), if they cannot be adequately managed by oral anticholinergic treatment due to lack of efficacy and/or intolerable side effects. Overall, there are limited data regarding therapy with intravesical oxybutynin, with the majority of publications being retrospective case series. To date, there are limited data on the efficacy and safety of the newly approved intravesical oxybutynin therapy (VESOXX®) in NDO patients. This noninterventional case series from daily routine treatment which evaluated the physician reports of 38patients suggests that intravesical oxybutynin effectively improves maximum detrusor pressure (Pdet max) by decreasing it by 59% from 51.94 cmH2O ± 26.12 standard deviation (SD) to 21.07 cmH2O ± 17.32 SD (P < 0.001, n = 34). Maximum bladder pressure (MBC) increased by 34% from 260.45 ml ± 200.26 SD to 348.45 ml ± 175.90 SD. Positive or similar effects compared to previous therapies were seen in bladder morphology, number of incontinence episodes, urinary tract infections and adverse drug effects. This case series demonstrates that intravesical oxybutynin is an important addition to current therapies for the treatment of NDO and it is also efficacious in the rare setting of other underlying diseases beyond spinal cord injury or spina bifida. The approved intravesical oxybutynin preparation VESOXX® may be auseful alternative for patients who do not respond to other therapies or suffered side effects.