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Original research
Randomized control trial of a holographic needle guidance technique for thoracic epidural placement
  1. Julian Wiegelmann1,2,
  2. Stephen Choi1,2,
  3. Paul G McHardy1,2,
  4. Clyde Matava2,3,
  5. Oskar Singer1,2,
  6. Lilia Kaustov1 and
  7. Fahad Alam1,2
  1. 1Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  2. 2Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
  1. Correspondence to Dr Fahad Alam, Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; fahad.alam{at}sunnybrook.ca

Abstract

Introduction The Microsoft HoloLens is a head-mounted mixed reality device, which allows for overlaying hologram-like computer-generated elements onto the real world. This technology can be combined with preprocedural ultrasound during thoracic epidural placement to create a visual of the ideal needle angulation and trajectory in the users’ field of view. This could result in a technically easier and potentially safer alternative to traditional blind landmark techniques.

Methods Patients were randomly assigned to one of two groups: (1) HoloLens-assisted thoracic epidural technique (intervention—group H) or (2) traditional thoracic epidural technique (control—group C). The primary outcome was needling time (defined as skin puncture to insertion of epidural catheter) during the procedure. The secondary outcomes were number of needle punctures, number of needle movements, number of bone contacts, and epidural failure. Procedural pain and recovery room pain levels were also evaluated.

Results Eighty-three patients were included in this study. The primary outcome of procedure time was reduced in the HoloLens group compared with control (4.5 min vs 7.3 min, p=0.02, 95% CI), as was the number of needle movements required (7.2 vs 14.4, p=0.01), respectively. There was no difference in intraprocedure or postprocedure pain, bone contacts, or total number of needle punctures. Three patients in the control group experienced epidural failure versus one patient in the HoloLens group.

Conclusions This study shows that thoracic epidural placement may be facilitated by using a guidance hologram and may be more technically efficient.

Trial registration number NCT04028284.

  • Injections, Spinal
  • Methods
  • Pain Management

Data availability statement

Data are available on reasonable request. Not applicable.

https://doi.org/10.1136/rapm-2023-104703

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    Data availability statement

    Data are available on reasonable request. Not applicable.

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    Footnotes

    • Contributors JW and FA conceived the study. JW developed the software/equipment related to needle guidance. FA, CM, SC, PGM and OS participated in HoloLens device training, and system design guidance. JW and FA performed a literature search and were the major contributors in writing this manuscript. LK assisted with study coordination and data gathering. All authors edited the final version of the manuscript. All authors read and approved the final manuscript. JW is the guarantor of this manuscript.

    • Funding This work was supported by a grant from the Academic Health Sciences Centre Alternative Funding Plan, IFPOC (SHS-18-009).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.