Karsten Lomholt Lassen - Institutionen för hälsovetenskaper

Title: Virtual reality (VR) applied perioperatively

Main supervisor: Pether Jildenstål, Department of Health Sciences, Medical Faculty, Lund University.

Reviewers: Hanne Konradsen, Professor, Senior Researcher, Department of Geriatric Medicine and Palliative Care, Amager and Hvidovre Hospital

David Haage, Associate Professor, Department of Health science, Mid Sweden University, Stockholm

Caroline Larsson, PhD, Department of Human Movement: health and rehabilitation, Lund University

Abstract

Background

Virtual Reality (VR) has emerged as a non-pharmacological tool that potentially can reduce pain, anxiety, and sedation needs during surgical procedures. By engaging attentional and affective networks, immersive VR modulates central pain processing and emotional regulation. Despite some promising study results across outcomes, the implementation of VR in clinical practice remains limited, calling for rigorous evaluation of its effectiveness, mechanisms, and feasibility in real-world perioperative settings.

Research questions

1. What is the current evidence for VR’s effect on pain and anxiety in adult patients undergoing elective surgery?
2. Can VR as a media for preoperative information in patients undergoing total knee arthroplasty (TKA) improve outcomes regarding anxiety, expectations, readiness?
3. What are the patients experience regarding receiving preoperative information through immersive VR?
4. What are the effects of VR distraction during extracorporeal shock wave lithotripsy (ESWL) on pain, anxiety, and physiological stress markers?

Preliminary results

The published systematic review and meta-analysis (study 1) demonstrates that VR is a safe intervention associated with significant reductions in pain and anxiety across surgical contexts. The published qualitative study (study 2) provides further insight into how immersive VR can serve as a preoperative information modality by supporting individualized information needs and promoting patient engagement. While these findings underscore the potential of VR, successful implementation depends on ensuring that technical solutions function as intended and optimizing the conditions for delivering information according to individual needs. Importantly, technology cannot replace the information provided by healthcare professionals, it should be regarded as a supplement.

Preliminary analyses from the RCT on ESWL indicate that NRS pain scores remained stable between 500 J and 900 J in the VR group, whereas a significant increase was observed in the control group.

Significance 

This doctoral project contributes new knowledge in the field of perioperative care by adding evidence and understanding in what degree immersive VR can optimize patient experiences and reduce anxiety and pain for awake surgery adjunct to pharmacological solutions. The results support VR as part of a multimodal, patient-centered strategy to improve perioperative outcomes and efficiency in healthcare systems.

Published studies

1. Lassen, K. L., Hermander K,  Jildenstål P, et al. 2025. “ Virtual Reality Is Safe and Can Reduce In-Hospital Anxiety and Pain: A Systematic Review With Meta-Analyses and Trial Sequence Analyses.” European Journal of Pain 29, no. 10: e70165. https://doi-org.ludwig.lub.lu.se/10.1002/ejp.70165.
2. Lassen, K. L., Sjöberg, C., Augustinsson, A., et al. (2025). The Virtual Reality Tour: Immersive Preoperative Information for Elderly Patients. Healthcare, 13(22), 2896. https://doi.org/10.3390/healthcare13222896