The effect of virtual reality on pain associated with venous access in children presenting to the emergency department: A systematic review and meta-analysis.

AIMS: To evaluate VR's effectiveness for pain relief during pediatric venous access procedures in emergency departments. METHODS: Using the PRISMA framework, a systematic search was undertaken across prominent databases up to February 1, 2025. Randomized controlled trials (RCTs) involving children under 18 undergoing venous access and using VR as an intervention were included. Meta-analyses were executed using standardized mean differences and random-effects models. RESULTS: Twelve RCTs (children 6 months-18 years) were included. VR decreased pain in the single-stage format significantly (SMD= -0.48; 95% CI: -0.70 to -0.26; I2 = 66.3%; moderate certainty). In the two-stage format (change from baseline), VR also showed a significant effect (SMD= -0.37; 95% CI: -0.65 to -0.09; I2 = 65.3%). Meta-regression revealed a non-significant trend toward greater efficacy in older children. CONCLUSION: The current evidence suggests a modest analgesic benefit for VR during pediatric venous access. Nonetheless, the presence of approximately 66% heterogeneity and the observation that merely one of the twelve included trials demonstrated low risk of bias render these findings preliminary and warrant prudent interpretation. Future RCTs should adopt a standardized approach, measuring pain before, during, and after the intervention, to better capture pain dynamics.