• James Sungjai Cho, Rohan Jotwani, Stephanie Chan, Devaunsh Manish Thaker, Jungmin Daniel On, R Jason Yong, and David Hao.
• Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA jcho@mgh.harvard.edu.
• Reg Anesth Pain Med. 2024 May 16.

BackgroundExtended 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.ObjectiveThis 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 ReviewA 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.FindingsThirteen studies using XR for procedural navigation are included. The evidence includes randomized controlled trials, retrospective studies, and case series.ConclusionsEarly 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.© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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