Date of this Version

2024

Document Type

DNP Project

Rights

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Abstract

Background: Poorly managed postoperative pain can severely impact patient recovery and quality of life, potentially leading to prolonged opioid use and chronic pain. Effective multimodal pain management, including esmolol infusions, can mitigate these issues by reducing opioid dependence and recovery time. This project aims to educate anesthesia providers on using esmolol as a nonopioid adjunct for the management of postoperative pain, emphasizing its benefits over traditional opioid use. Esmolol has been shown to have antinociceptive properties reducing postoperative pain, opioid consumption, and related adverse effects without significantly altering hemodynamics. This project also explores the comparison between esmolol and dexmedetomidine, a well-known nonopioid adjunct, highlighting the need for future research on their efficacy in preventing postoperative pain. Addressing these knowledge gaps and incorporating esmolol into pain management strategies can improve patient outcomes, reduce opioid use, and enhance patient satisfaction.

Methods: Participant recruitment occurred via email, emphasizing voluntary participation and anonymity. Accessible on any smart device, the module begins with a pre-module assessment to gauge baseline knowledge and attitudes toward nonopioid adjuncts. Participants then viewed a voiceover PowerPoint on multimodal analgesia and esmolol’s effectiveness, followed by a post-module assessment to measure knowledge gained and willingness to adopt new practices. Data from pre- and post-module assessments was stored securely in a password-protected Qualtrics account, anonymized for privacy, and manually entered into Microsoft. Comparative analysis determined statistical significance. The project is approved by the Institutional Review Board (IRB) of Florida International University.

Results: Provider knowledge and attitudes on incorporating esmolol into multimodal pain management strategies increased after viewing the educational module. Overall, there was an increase in knowledge from pre-test to post-test among all questions. There was a shift in provider attitude both away from the use of opioids and towards the implementation of esmolol into their practice.

Discussion: This project aimed to educate anesthesia providers on using esmolol as a nonopioid adjunct to prevent postoperative acute pain. The implementation site’s strength lies in its potential to extend the project's impact through preceptorship. However, project limitations included a small sample size (n=11), single-center focus, and narrow distribution. Expanding to a multi-center study with a longer duration and diverse delivery methods could improve participation and reduce biases. The project's educational module, accessible online, included pre- and post-module assessments to evaluate provider knowledge and attitudes towards nonopioid adjuncts and opioid use. Although esmolol’s nociceptive mechanism remains unknown, the project increased provider willingness to modify practices and adopt multimodal analgesia strategies. Advanced practice nursing requires continuous learning, continuously applying evidence-based practice to improve practice. Esmolol's cardioprotective properties and known side effects underscore the importance of up-to-date research, especially for the aging population. The project's focus on reducing opioid use aligns with the theory of unpleasant symptoms, aiming to prevent discomfort and long-term effects of acute pain, including chronic pain.

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