Virtual Reality for Pain Management in Pediatric Phlebotomy: A Systematic Review

ABSTRACT Introduction: Pediatric phlebotomy is an invasive procedure often associated with negative sensory and emotional experiences, as it can induce pain and provoke anxiety and fear. While pharmacological interventions may alleviate these effects, they are limited by factors such as delayed onset of action and potential adverse effects. Virtual reality has emerged as a promising non-pharmacological alternative, offering an immersive, multisensory experience that can effec-tively engage and distract young patients during the procedure. Objective: To evaluate the effect of virtual reality (VR) on pain perception pain perception and anxiety-related outcomes in pediatric patients undergoing phlebotomy, comparing experiences with and without VR intervention. Methods: Systematic literature review, reported in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The research question was formulated using the PICO framework. Randomized clinical trials and comparative controlled studies published between January 2020, and September 2025 were included, involving partici-pants aged 4 to 17 years. Results: A total of six studies were included in the analysis. The interventions utilized immersive, play-based environments, educational content, and phlebotomy procedure simulations. Four studies demonstrated a significant reduction in pain among participants exposed to virtual reality compared to control groups, whereas the remaining two studies reported no significant differ-ences. The variability in clinical settings, types of VR devices, and pain assessment tools across studies, however, limits direct comparability of the findings and highlights the need for stand-ardized protocols in future research. Conclusion: Virtual reality is a promising strategy to reduce pain and anxiety during pedi-atric phlebotomy. Current evidence suggests potential effectiveness, but studies are limited by small sample sizes and methodological heterogeneity. Standardized protocols and infection control measures are essential for safe clinical implementation. Future well-designed trials are needed to confirm benefits and optimize intervention parameters.