Virtual reality for pain and anxiety management in children undergoing venipuncture procedures: A systematic review and meta-analysis

Virtual Reality immersion is a more recent form of distraction that may have been used in the pediatric setting for reducing pain and fear in children undergoing needle-based intravenous procedures. A systematic review and meta-analysis was conducted to determine the efficacy of Virtual Reality compared to non-pharmacological standard care in reducing periprocedural pain and anxiety. PubMed, Cochrane Central Register of Controlled Trials, and Google Scholar were searched from inception till March 5, 2023. Data was extracted by two reviewers and independently verified. The primary outcomes were patient-reported pain and fear using numerically graded scales. A total of 11 randomized controlled trials comparing the effect of VR with any form of non-pharmacological methods of pain and anxiety relief in children ≤ 12 years old were included. While the risk of bias across the studies was moderate, there was a high risk of bias regarding blinding of personnel and outcome assessment. A few studies also showed moderate attrition bias and the same in allocation concealment. VR reduced patient-reported pain (SMD = -1.55, 95% CI = -2.11 to -0.98, P<0.00001, I2 = 95%) and fear (SMD = -1.19, 95% CI = -1.64 to -0.74, P < 0.00001, I2 = 90%). This was consistent in our analysis of sub-groups, such as phlebotomy-associated pain (SMD = -1.84, 95% CI = -2.52 to -1.16, P<0.00001) and fear (SMD = -1.42, 95% CI = -1.86 to -0.97, P < 0.00001, I2 = 85%). Evidence suggests VR may be more effective than traditional non-pharmacological pain and fear relief. This result seems to be consistent through different procedures. More rigorous studies are required under standardized conditions to truly gauge the effect of VR.