Date of this Version

11-28-2023

Document Type

DNP Project

Abstract

Background: Pain is a common complication following cardiothoracic surgery. Despite being preventable, pain is reported to be moderate to severe in about 75% of patients. Poorly managed pain has been associated with a prolonged hospital stay, substantial psychological effects, chronic pain-related morbidity, and a higher incidence of post-sternotomy pain syndrome. Neuraxial approaches, such as thoracic epidurals and paravertebral blocks, are often avoided due to their hemorrhage risks and hemodynamic compromise. The lack of sufficient pain management justifies multimodal anesthesia (MMA) in patients undergoing cardiothoracic surgery (CTS). Reducing perioperative pain and narcotic consumption is an ongoing, evidence-based project effort. While current CTS guidelines support regional blocks as an adjuvant of MMA, a standardized technique remains in question.

Methods: The Quality Improvement (QI) project occurred at a 797-bed public hospital involving Certified Registered Nurse Anesthetists (CRNAs), physician anesthesiologists, and anesthesiology assistants. The project aimed to educate anesthesia providers on implementing the Erector Spinae Plane Block (ESPB) for CTS. The study involves a pre-assessment survey, an online educational module, and a post-intervention survey. Eight participants (n=8) were recruited through voluntary consent. The Institutional Review Board of Florida International University's approval is necessary, and confidentiality measures were strictly maintained. Data collection included pre-test and post-test surveys, assessing knowledge, attitudes, and willingness to implement ESPB. The lead investigator, a DNP student, used Qualtrics Stat-IQ software for data analysis, ensuring anonymity and password protection. Overall, the project evaluated the impact of the educational intervention and the potential for practice change among anesthesia providers.

Results: In the pre-test, 87.50% reported successful implementation for specific surgical procedures, increasing to 100.00% in the post-test, reflecting a 12.50% improvement. Recognition of correct ESPB placement rose from 75.00% to 100.00%, a 25.00% gain. Knowledge of immediate negative effects of high-dose opioids increased from 75.00% to 100.00%, a 25.00% gain, while long-term effects recognition remained at 100.00%. Initially, 87.50% found ESPB administration more challenging than thoracic epidurals, improving to 100.00% in the post-test, a 12.50% gain. Notably, participants' likelihood of using ESPBs for thoracic operations increased from 12.50% to 85.71%, a substantial 73.21% change; similar positive shifts were observed for open heart surgery (73.21%) and minimally invasive valve surgery (73.21%). Participants' attitudes and awareness about ESPBs during CTS changed significantly (100.00%) after the learning module, reflecting a positive shift in perspective and awareness.

Discussion: The results indicate positive changes in participants' knowledge and attitudes towards ESPBs. These findings highlight the positive impact of the educational intervention in transforming participants' likelihood of administering ESPBs for CTS, improving their understanding, confidence, and acceptance of this regional anesthesia technique for diverse surgical settings. The educational intervention was transformative, enhancing participants' awareness, comfort, and acceptance of ESPBs across various surgical procedures, particularly in patients undergoing CTS. This evidenced-based project supports the implementation of ESPBs for CTS patients, evidenced by fewer opioid requirements, decreased post-op ventilator times, early postoperative mobility, shorter ICU time, decreased hospital length of stay, fewer vasopressor requirements, hemodynamic swings, and shorter administration time. The emergence of ESPBs for CTS patients offers a safe and effective way to reduce narcotic consumption and pain to improve perioperative outcomes.

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