Effectiveness of extended reality in simulation-based ultrasound-guided regional anesthesia training: a systematic review
In brief
Augmented reality shortens ultrasound block needle time by about a third in training
In seven small studies of 137 trainees, AR head-mounted displays reduced needle insertion time (from 10 to 7 seconds and from 18 to 12 seconds) and improved needle visibility, while immersive VR showed no performance benefit. The evidence is limited by heterogeneous designs, tiny samples and an underpowered pilot trial, so XR remains experimental for regional anesthesia education.
- Journal
- Canadian journal of anaesthesia = Journal canadien d'anesthesie (Q1)
- Published
- 3 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Isabelle Lefebvre, Pierre-Marc Dion, Sylvain Boet, Reva Ramlogan, Hussein Said, Cian Devine, et al.
- PMID
- 42547756
- DOI
- 10.1007/s12630-026-03159-7
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 9 August 2026): High-quality evidence in a top journal
Abstract
PURPOSE: Ultrasound-guided regional anesthesia (UGRA) requires knowledge of anatomy, hand-eye coordination, and safe needling techniques. Extended reality (XR), including augmented reality, virtual reality (VR), and mixed reality, is an emerging simulation modality for UGRA training. We sought to conduct a systematic review to evaluate the current evidence on the effectiveness of XR for UGRA training. SOURCE: We searched MEDLINE, Embase®, the Cochrane Library, Web of Science®, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception to 15 November 2024. We included randomized controlled trials, observational studies, and case series. We categorized outcomes by Kirkpatrick levels and assessed risk of bias. PRINCIPAL FINDINGS: From 1,703 articles, we included seven studies (N = 137 participants). Four studies reported participant reactions. One trial (n = 29) found higher self-confidence in anatomical landmark identification and procedural performance (P < 0.001). One study assessed knowledge, reporting a score increase (P < 0.001). Augmented reality head-mounted display studies found shorter procedure times (10 vs 7 sec; P = 0.03 and 18 vs 12 sec; P = 0.002), higher needle visibility (34% vs 57%; P < 0.001 and 20% vs 38%; P = 0.001), and fewer head movements (P = 0.02). Immersive VR trials found no between-group differences in ratings or error scores (mean difference, -3.3; 95% confidence interval, -12.7 to 6.1; P = 0.51). The only randomized controlled trial was a pilot study that was terminated early and was underpowered for outcomes. We found substantial variability in XR definition, study design, methodologic rigour, and study quality. CONCLUSIONS: The current evidence does not conclusively support widespread adoption of XR for UGRA training, owing to heterogeneity, small samples, and underpowered studies. Currently, XR remains at an early and experimental stage in development. STUDY REGISTRATION: PROSPERO ( CRD42023424194 ); first submitted 18 May 2023.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.