Background: Current paediatric postoperative pain management relies on pharmaceutical therapies, haunted by unfavourable side effects. As a nonpharmacological intervention, virtual reality stands out due its novelty, flexibility and safety. The efficacy consistency and mechanism of virtual reality in altering children postoperative pain demands further investigation.
Method: A systematic search was conducted in PubMed, Cochrane Library, MEDLINE (OVID), Embase, and EBSCO until January 2025. Randomized controlled trials (RCTs) of Intervention-related virtual reality in pediatric postoperative pain reduction were included. A classical meta-analysis using a random effect maximum likelihood model (REML) was deployed to summarize standardized mean difference (SMD) in 95% Confidence interval (CI). Sensitivity analysis was performed by excluding outliers and studies with a high risk of bias.
Result: 9 of 458 RCTs highlighted a large effect of pain reduction with virtual reality (SMD = -1.98, 95% CI: - 2.58, -1.39, I2 = 97.1 %, P<0.001). A sensitivity analysis minimized the heterogeneity and size effect (SMD = -0.29, 95% CI, - 0.48, 0.10, I2 = 34.8 %, P=0.003). The virtual reality mediated nature-based, game, video animation, and surgical layout with varying immersion and interactivity.
Conclusion: Virtual reality yields a clinical benefit in altering pain perception. The magic of VR in modulating pain lies within immersion, presence, and agency. Active engagement in distraction, multisensory stimuli in relaxation, and memory re-framing in conditioning play significant roles in distorting children's pain perception after operation.