Virtual Reality-Based Anxiety Reduction Before Elective Surgical Procedures

Abstract

Preoperative anxiety is a common and clinically consequential feature of elective surgery, associated with heightened postoperative pain, greater analgesic requirements, and lower patient satisfaction, which has driven interest in non-pharmacologic alternatives to benzodiazepine premedication. This review synthesizes recent randomized controlled trials and meta-analyses examining immersive virtual reality (VR) as an anxiolytic intervention across the elective surgical pathway, from adult and pediatric preoperative holding areas through induction of anesthesia and, more recently, intraoperative use during regional anesthesia. Across pooled analyses in adults and children, VR consistently reduces validated anxiety scores relative to standard care, with larger effects for interactive rather than passive content and for exposure timed close to the anxiety-provoking event, while the advantage narrows when compared against an active non-immersive distraction rather than no distraction. Pediatric trials additionally show improved induction compliance and feasibility for integration into perioperative workflow, and early intraoperative work suggests a role during awake regional anesthesia cases as well. We conclude that VR is a promising and low-risk adjunct to existing anxiolytic strategies, though larger pragmatic trials with active comparators and formal cost-effectiveness analysis are needed before it can be considered a protocolized standard of care.