Background: Chronic opiate use in traumatic and surgical wound management has become an increasingly
controversial topic nationally. Here we present a case of a large surgical wound previously managed with
operative dressing changes with significant opiate use for pain control with the use of virtual reality at the
time of dressing changes to decrease opiate use as well as operative need; and therefore, overall cost.
Case Presentation: The patient is a 57-year-old female with morbid obesity and poorly controlled diabetes
mellitus who presented with a necrotizing soft tissue infection of the left thigh. She was admitted to the
intensive care unit, initiated on broad spectrum antibiotics, and taken to the operating room for excisional
debridement. After stabilization and source control, the patient continued to require operative incisional
wound vac changes every other day despite maximal multimodal pain therapy. After discussion with the
patient regarding her continued ongoing operative wound vac changes and her desire to progress care, the
team attempted a bedside dressing change utilizing the Facebook Oculus Quest Virtual Reality device
application “Nature Treks VR”. The patient endorsed reduced pain scores during the dressing change and
endorsed emersion into the virtual world throughout the dressing change.
Conclusion: To the best of our knowledge this is the first reported incidence of using a virtual reality
platform to reduce opiate use, operative need, progression of care, and overall cost in a patient with a large,
debilitating operative wound outside of the burn population. Advances in virtual reality hardware including
tether less systems like Oculus Quest, non-controller hand tracking and headset sanitation devices have
reduced barriers to introducing virtual reality therapy into the clinic and ICU. A prospective study is needed
to validate the use of virtual reality as a distraction therapy at the time of dressing changes. Future use of
virtual reality may involve reducing ICU delirium, targeted pain management, post trauma recovery
exercises and enhanced rehabilitation of amputees with prosthetic devices.
Use of Virtual Reality as a Distraction Technique to Limit Opiate Use in Traumatic and Surgical Wound Dressing Management
