Background: Spinal anesthesia maintains patient consciousness during surgery, potentially increasing intraoperative stress and anxiety. Traditional pharmacological anxiolytics carry risks, including respiratory depression and delayed recovery. Objectives: This study aims to evaluate the impact of immersive virtual reality (VR) on intraoperative stress markers, hemodynamic stability, and patient satisfaction in patients undergoing elective urological surgery under spinal anesthesia. Methods: A prospective, assessor-blinded randomized controlled trial was conducted from June to September 2024 at Rafidia Governmental Surgical Hospital in Palestine. A total of 145 patients were randomly assigned to the VR group (n=72) receiving immersive VR therapy or the control group (n=73) receiving standard care. Primary outcomes included anxiety assessed via State-Trait Anxiety Inventory (STAI), hemodynamic parameters, and patient satisfaction via Visual Analog Scale (VAS). Physiological stress markers, including salivary cortisol and heart rate variability (HRV), were measured at baseline, intraoperatively, and postoperatively. Statistical analysis utilized independent t-tests and repeated measures analysis. Missing data were handled using intention-to-treat principles with last observation carried forward for any incomplete assessments. Results: The VR group demonstrated significantly reduced salivary cortisol levels (15.2 ± 4.1 vs. 22.8 ± 5.3 nmol/L, p<0.001) and improved HRV parameters (RMSSD: 42.1 ± 8.2 vs. 31.5 ± 7.6 ms, p<0.001) compared to the controls. The VR group also demonstrated significantly reduced intraoperative anxiety scores and sustained postoperative anxiety reduction compared to controls. Patient satisfaction scores were substantially higher in the VR group. Hemodynamically, the VR group showed significantly lower heart rates intraoperatively, while other parameters remained stable. Conclusions: Immersive virtual reality is a safe and effective non-pharmacological intervention that reduces intraoperative stress and anxiety while improving patient satisfaction during spinal anesthesia. VR may be considered for integration into perioperative care protocols, particularly in resource-constrained settings. Clinical Trial Registration: AEA Registry (AEARCTR-0013093), registered February 23, 2024.

Background: Spinal anesthesia maintains patient consciousness during surgery, potentially increasing intraoperative stress and anxiety. Traditional pharmacological anxiolytics carry risks, including respiratory depression and delayed recovery. Objectives: This study aims to evaluate the impact of immersive virtual reality (VR) on intraoperative stress markers, hemodynamic stability, and patient satisfaction in patients undergoing elective urological surgery under spinal anesthesia. Methods: A prospective, assessor-blinded randomized controlled trial was conducted from June to September 2024 at Rafidia Governmental Surgical Hospital in Palestine. A total of 145 patients were randomly assigned to the VR group (n=72) receiving immersive VR therapy or the control group (n=73) receiving standard care. Primary outcomes included anxiety assessed via State-Trait Anxiety Inventory (STAI), hemodynamic parameters, and patient satisfaction via Visual Analog Scale (VAS). Physiological stress markers, including salivary cortisol and heart rate variability (HRV), were measured at baseline, intraoperatively, and postoperatively. Statistical analysis utilized independent t-tests and repeated measures analysis. Missing data were handled using intention-to-treat principles with last observation carried forward for any incomplete assessments. Results: The VR group demonstrated significantly reduced salivary cortisol levels (15.2 ± 4.1 vs. 22.8 ± 5.3 nmol/L, p<0.001) and improved HRV parameters (RMSSD: 42.1 ± 8.2 vs. 31.5 ± 7.6 ms, p<0.001) compared to the controls. The VR group also demonstrated significantly reduced intraoperative anxiety scores and sustained postoperative anxiety reduction compared to controls. Patient satisfaction scores were substantially higher in the VR group. Hemodynamically, the VR group showed significantly lower heart rates intraoperatively, while other parameters remained stable. Conclusions: Immersive virtual reality is a safe and effective non-pharmacological intervention that reduces intraoperative stress and anxiety while improving patient satisfaction during spinal anesthesia. VR may be considered for integration into perioperative care protocols, particularly in resource-constrained settings. Clinical Trial Registration: AEA Registry (AEARCTR-0013093), registered February 23, 2024.