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Background and Aims Virtual reality (VR) headsets may complement sedation during the performance of nerve blocks, providing additional dissociative effect. On the other hand, the use of such devices may increase the risks of inadvertent nerve, vessel and lung punctures caused by patient movement, as well as augment the emetic effects of the drugs used to provide sedation. We aimed to compare such risks in a specific patient population - soldiers with blast and gunshot injuries.Methods Patients with blast and gunshot limb injuries undergoing surgical interventions under regional anesthesia with moderate (conscious) sedation were randomly distributed into two groups: with addition of virtual reality devices (group VR) and without them (group non-VR). Incidence of common anesthesia-related complications was compared. Chi-square test and t-test were used to calculate the statistical significance where appropriate.Results A total of 104 patients were included (45 in VR group and 59 in non-VR group). Clinically significant nerve damage (causing lasting muscle weakness or paresthesia) was registered in 1 patient in VR group and 2 in non-VR group (p = 0.72). Nausea was more common in the VR group (7 vs 2, p = 0.02). No vomiting was observed in either group. Undesirable patient movement during the surgical intervention, VR vs non-VR: 15 vs 18 (p = 0.75). Use of VR devices has increased the duration of preparation within the operating theater by 134 ± 35 seconds. No significant difference in propofol consumption (mg/kg/hour) was observed (VR: 4.2 ± 1.5, non-VR: 4.3 ± 1.7, p = 0.75).Abstract OP46 Figure 1A patient undergoing secondary wound debridement following a popliteal blockConclusions During treatment of combat injuries under regional anesthesia with moderate sedation, the use of virtual reality headsets does not appear to result in an increased incidence of anesthesia-related complications with an exception of manageable nausea, which is more common when VR devices are used.