Date of this Version

11-8-2024

Document Type

DNP Project

Abstract

Background: This evidence-based module project aimed to discover a regional anesthetic that can produce better patient outcomes after laparoscopic surgeries, as pain remains an issue for up to 70% of patients because of the addition of visceral pain that is a result of the pneumoperitoneum needed to proceed laparoscopically. Untreated post-op pain leads to prolonged recovery, dissatisfaction, exacerbation of comorbidities, and worse outcomes. Currently, anesthesia providers use opioids or perform a TAP block to combat this pain. A TAP block can be inconsistent in blocking necessary spinal levels and does not contain visceral pain-relieving effects. An ESP block is a novel technique that has been increasingly used across various surgeries with promising results in pain-relieving effects due to its wide coverage of analgesia and visceral pain-relieving effects.

Methods: The researcher reviewed PubMed, Medline, and Embase. Studies included were published within the years of 2017-2023, only RCTs, with participants within the age range of 18-65 years old, written in English, had full-text available, and pertained to the QI topic. The exclusion criteria encompassed studies that did not have an ESP or TAP block as an intervention, surgery routes other than laparoscopic, pediatric patients, elderly patients, or written in another language. 127 articles were initially identified; however, after duplicates were removed and applying the inclusion and exclusion criteria, 15 articles were found and selected. After IRB exemption was obtained, an online educational module was created with the intention to send to selected anesthesia staff at a designated facility. Pre and post qualitative surveys were collected over an 8-week period and aggregate data were analyzed by Qualtrics. The plan is to disseminate at the AANA national conference and to make an evidence-based protocol for clinical practice.

Results: CRNAs and Anesthesiologists of different age groups and years of experience from a level I trauma center were invited to participate in this educational module to assess their knowledge in treating pain postoperatively after laparoscopic surgeries. 56 surveys were sent out, with only 11 participants completing it fully (19.6% response percentage). 11 participants from a level I trauma center consented to the educational module before preceding to complete the demographics, pre-survey, educational video, and post-survey. Pre survey results showed that majority of providers did could not correctly identify how much pain patients feel postop (64%) or the type of pain relief that a TAP block provides (55%). However, most knew what kind of pain was felt post op (64%), blocks to use to treat it (82%), and how an ESP block relieved pain (64%). Post survey showed an increase in knowledge in most of the areas, which proves the success of the educational module.

Discussion: Post-operative pain remains a critical unsolved issue that leaves the patient vulnerable to post-operative complications. IV analgesia has shown inferior patient outcomes post-operatively in patient outcomes when compared to regional anesthetic techniques. Current research concludes that a multimodal approach with the inclusion of an ESP block prior to or immediately after a laparoscopic procedure was found to be the most effective way to treat post-operative pain because of its visceral pain- relieving effects and its ability to provide a wider analgesia coverage. Across the eight articles chosen in the final selection, ESP blocks have shown to decrease opioid consumption, pain scores, PCA pump usage, and receive higher patient satisfaction based on questionaries. Evidence across the remaining seven articles that TAP blocks have also proposed similar results, further proving that regional anesthesia equates to better outcomes. The post survey revealed that some providers would consider using an ESP block in their plan, while others were unlikely too. Limitations included possible low survey participation due to virtual delivery.

Keywords: Laparoscopic Surgery, Post-operative Pain, Erector Spinae Plane (ESP) block, Transversus Abdominis Plane Block (TAP)

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