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Background: Chronic opiate use in traumatic and surgical wound management has become an increasinglycontroversial topic nationally. Here we present a case of a large surgical wound previously managed withoperative dressing changes with significant opiate use for pain control with the use of virtual reality at thetime 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 diabetesmellitus who presented with a necrotizing soft tissue infection of the left thigh. She was admitted to theintensive care unit, initiated on broad spectrum antibiotics, and taken to the operating room for excisionaldebridement. After stabilization and source control, the patient continued to require operative incisionalwound vac changes every other day despite maximal multimodal pain therapy. After discussion with thepatient regarding her continued ongoing operative wound vac changes and her desire to progress care, theteam attempted a bedside dressing change utilizing the Facebook Oculus Quest Virtual Reality deviceapplication “Nature Treks VR”. The patient endorsed reduced pain scores during the dressing change andendorsed 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 realityplatform 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 includingtether less systems like Oculus Quest, non-controller hand tracking and headset sanitation devices havereduced barriers to introducing virtual reality therapy into the clinic and ICU. A prospective study is neededto validate the use of virtual reality as a distraction therapy at the time of dressing changes. Future use ofvirtual reality may involve reducing ICU delirium, targeted pain management, post trauma recoveryexercises 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