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.