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Review
Extended reality navigation for pain procedures: a narrative review
  1. James Sungjai Cho1,2,
  2. Rohan Jotwani3,
  3. Stephanie Chan4,
  4. Devaunsh Manish Thaker5,
  5. Jungmin Daniel On6,
  6. R Jason Yong7,2 and
  7. David Hao1,2
  1. 1Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Harvard Medical School, Boston, Massachusetts, USA
  3. 3Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
  4. 4St George's University, St George's, Grenada
  5. 5Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Langone Health, New York, New York, USA
  6. 6Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
  7. 7Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr James Sungjai Cho, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; jcho{at}mgh.harvard.edu

Abstract

Background Extended reality (XR) technology, encompassing virtual reality, augmented reality, and mixed reality, has been widely studied for procedural navigation in surgical specialties. Similar to how ultrasound transformed regional anesthesia, XR has the potential to reshape how anesthesiologists and pain physicians perform procedures to relieve pain.

Objective This narrative review examines the clinical benefits of XR for navigation in various pain procedures. It defines key terms and concepts related to XR technology and explores characteristics of procedures that are most amenable to XR-based navigation. Finally, it suggests best practices for developing XR navigation systems and discusses the role of emerging technology in the future of XR in regional anesthesia and pain medicine.

Evidence review A search was performed across PubMed, Embase, and Cochrane Central Register of Controlled Trials for primary literature investigating the clinical benefits of XR navigation for pain procedures.

Findings Thirteen studies using XR for procedural navigation are included. The evidence includes randomized controlled trials, retrospective studies, and case series.

Conclusions Early randomized controlled trials show potential for XR to improve procedural efficiency, but more comprehensive research is needed to determine if there are significant clinical benefits. Case reports demonstrate XR’s utility in generating patient-specific navigation plans when difficult anatomy is encountered. Procedures that facilitate the generation and registration of XR images are most conducive to XR navigation, whereas those that rely on frequent re-imaging will continue to depend on traditional modes of navigation.

  • TECHNOLOGY
  • Pain Management
  • Ultrasonography
  • Patient Simulation
  • Nerve Block

https://doi.org/10.1136/rapm-2024-105352

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    Footnotes

    • X @depthanesthesia

    • Contributors JSC contributed to the conception and design of the study, data acquisition, analysis, interpretation, manuscript drafting, and critical revision. RJ made contributions to the study conception and design, manuscript drafting, data analysis, and critical revision. SC contributed to manuscript drafting, data screening, extraction, and critical revision. DMT participated in data screening, extraction, analysis, manuscript editing, and critical revision. JDO participated in data extraction, manuscript editing, and critical revision. RJY and DH provided mentorship throughout the review process, contributing to study design, manuscript editing, data analysis, and critical revision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests RJ is a scientific board advisor for 3D Organon. He owns no shares and receives no financial remuneration for his work. The other authors declare no conflicts of interest.

    • 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.