Date of this Version

2024

Document Type

DNP Project

Rights

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Abstract

Background: Over 600,000 total knee arthroplasty (TKA) procedures are performed in the United States. Recovery and return to daily living activities are highly dependent on pain management. Current approaches, include peripheral nerve blocks, opioid administration, and non-opioid analgesia, have limitations such as short duration of action and potential opioid-related complications. Cryoneurolysis can improve and initiate pain management before undergoing this surgical procedure. The purpose of this quality improvement project was for anesthesia providers to increase anesthetic knowledge through an educational module about how the use of cryoneurolysis to the infrapatellar branch of the saphenous nerve (ISN) and the anterior femoral cutaneous nerve (AFCN) can improve multimodal pain management by reducing opioid consumption, hospital length of stay, and knee rehabilitation functionality.

Methods: A literature review was conducted using the Cochrane Review, PubMed, MEDLINE, and Embase databases. The search keywords included cryoneurolysis, pain management, and total knee arthroplasty. Ten articles were included for review. IRB was exempt from Florida International University. A pre-test questionnaire was given via Qualtrics, consisting of 10 items to determine baseline knowledge. The pre-test was followed by a 10-minute educational video on using cryoneurolysis as a pain management technique for patients undergoing total knee arthroplasty focused on anesthesia providers at a level 1 trauma center. A post-test questionnaire mirroring the pre-test was conducted after the teaching module to assess for increases in knowledge. Descriptive statistics were used to compare pre- and post-test questionnaires via data gathered in the Qualtrics platform.

Results: There was an improvement in anesthesia provider knowledge after the educational module presentation. Thirteen participants consented to participate in the pre-test and post-test questionnaire. Overall, there was an increase in provider knowledge, particularly on the identification of nerves typically targeted during cryoneurolysis for total knee arthroplasty, the projected incidence rate of this procedure, and understanding of the mechanism of action of cryoneurolysis. The implementation of this quality improvement project demonstrated an expansion and rise of knowledge of the cryoneurolysis technique for pain management for patients undergoing total knee arthroplasty.

Discussion: The use of cryoneurolysis to the infrapatellar branch of the saphenous nerve and the anterior femoral cutaneous nerve 1 to 2 weeks prior to a total knee arthroplasty can significantly reduce opioid consumption, improve knee functionality, decrease hospital length of stay, and overall enhance patient satisfaction. The implementation of a pre-test, educational module, and post-test questionnaire educating anesthesia providers about the use of cryoneurolysis demonstrated an overall increase in knowledge on the benefits of cryoneurolysis for pain management. Limitations of this quality improvement project included participant sample size and time allotment frame. The incorporation of cryoneurolysis into multimodal pain management protocols allows for superior pain control, avoiding the risk of chronic pain development and long-term use of opioids.

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