Date of this Version

12-6-2023

Document Type

DNP Project

Abstract

Abstract

Background: Total knee arthroplasty (TKA), an effective surgical intervention for knee arthritis pain, is one of the most common musculoskeletal procedures in the United with over 719,000 procedures performed each year and expected to reach over three million by 2030.1

Most patients report moderate to severe pain after TKA. Postoperative pain presents significant complications, such as delayed recovery, poor sleep quality, altered appetite, and decreased functional exercise.2 Currently, opioid is the most common analgesics used in the perioperative management of TKA patients. The literature shows there is a rise in opioid prescription, coinciding with the rise in opioid abuse nationwide.2 This quality improvement (QI) project aimed to educate local anesthesia and surgical providers on the analgesic benefits of adductor canal block (ACB) as an effective opioid-sparing analgesic to address the current opioid abuse health crisis rising in the United States healthcare system.

Methods: This QI project was conducted at a large seven-hundred and sixteen-bed, level-one trauma community hospital in Broward County, Fort Lauderdale, FL. A list of all available anesthesia providers, including Anesthesiologists and Certified Registered Nurse Anesthesiologists, names, and email contacts were collected. A total of forty-five invitations to participate in an online learning module were sent out via the provided email. A total of four invitees consented and participated in the QI module. After completing the learning module, all 4 participants completed a pre-test survey administered before and a post-test survey administered after the completion of the learning module. The pre-test and post-test survey questions measured the provider's baseline and gained knowledge of postoperative complications of TKA, the long-term effect of high narcotic use, understanding of regional nerve block as an alternative to high narcotics technique, and the difference and benefits of ACB versus FNB.

Results: The pre-test survey showed that the majority of the participants were aware of postoperative TKA complications and the potential complications from high narcotic postoperative pain management techniques. All participants agreed that regional anesthesia can be an excellent alternative to narcotics to help mitigate these complications. However, only half of the participants knew of the indications and benefits of ACB in the perioperative treatment of TKA patients. The post-test survey results showed a positive relationship between improved knowledge through educational instruction and an increased inclination to use regional anesthesia as part of the multimodal pain management protocol.

Conclusion: This QI project can help improve future anesthesia practice to reduce narcotic use in the perioperative pain management of TKA patients. This QI project aimed to educate local anesthesia providers on the analgesic benefits of ACB as an effective opioid-sparing analgesic to address the current opioid abuse health crisis rising in the United States healthcare system. Overall, the participants demonstrated an increased understanding of the benefit and usability of ACB to reduce postoperative pain while limiting the risk of delayed rehabilitation and avoiding the development of opioid dependence and abuse.

Keywords: adductor canal block, analgesic, arthroplasty, femoral nerve block, knee, rehabilitation

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