Efficacy of active and passive virtual reality distraction during local anesthesia in children 

Abstract Objective The aim of this study is to compare active distraction (playing video games) and passive distraction (watching cartoon videos) using a Virtual Reality (VR) device, in reducing pain associated with local anesthesia injection in children. Materials and methods This double-blind RCT included 82 healthy children (6–10 years old) who were divided equally into active distraction (AD) and passive distraction (PD) groups. Pain was assessed during and after the IANB injection using Wong-Baker FACES ® pain rating scale (WBF), Faces, Legs, Activity, Cry, Consolability (FLACC) Behavioral Pain Rating Scale, and heart rate (HR) monitoring. Mann-Whitney U and t-tests were used to achieve the statistical analysis. Results Injection-related pain assessment showed converging values for the two types of distraction where there were no significant differences between AD and PD groups according to subjective (P = 0.372 ˃ 0.05), and behavioral (P = 0.439 ˃ 0.05) scales. The HR changes (The difference between the highest HR value during the injection and the baseline HR value) showed no significant differences between the study groups (P = 0.245 ˃ 0.05). Conclusion The VR device reduces pain during local anesthesia in cooperative children regardless of the type of distraction with little advantage for active distraction over passive distraction. Clinical significance: The use of the VR device on children is considered an effective, safe, and non-pharmacological distraction technique. Trial registration Clinicaltrials, NCT05129943, (https://clinicaltrials.gov/ct2/show/NCT05129943).