Virtual reality combined with patient-controlled anaesthesia for pain management during pancreatic extracorporeal shockwave lithotripsy

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Objective Extracorporeal shock wave lithotripsy (ESWL) for pancreatic duct stones is effective but painful. We aimed to evaluate whether combining virtual reality (VR) with remifentanil patient-controlled analgesia (PCA) reduces opioid consumption and improves recovery after pancreatic ESWL. Methods We conducted a single-centre observational before–after study including consecutive pancreatic ESWL sessions performed between 2019 and 2023 in patients with chronic pancreatitis. Patients treated before November 2020 received remifentanil target-controlled infusion (control group), whereas those treated thereafter received remifentanil PCA combined with VR (VR+PCA group). The primary outcome was the total remifentanil dose administered during ESWL. Multivariable models were adjusted for patient demographics, substance use and chronic pancreatitis characteristics. Results A total of 131 ESWL sessions were included: 35 in the control group and 96 in the VR+PCA group. The mean patient age was 55 years, 30% were women, and pancreatic stones had a mean size of 14 mm, with 82% located in the pancreatic head. Patients in the VR+PCA group received less remifentanil during ESWL (147 µg vs 196 µg, p<0.001). In postanaesthesia care unit, they were more frequently fully awake (96% vs 73%, p<0.01), required less frequently morphine titration (2% vs 12%, p=0.02) and had a shorter stay (27 min vs 53 min, p<0.001). Procedure duration and quality were similar between groups. No complications were attributed to VR or PCA. Conclusion Combining VR with remifentanil PCA during pancreatic ESWL was associated with reduced opioid consumption and faster recovery without compromising safety, supporting VR as a feasible adjunct to analgesia in this setting.

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