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DNP Project





Background: Illegal use and abuse of opioids is a massive problem in the United States, with significant financial and emotional burdens. Surgeries in the thoracic cavity are some of the most painful surgeries endured by patients. With the discovery of the erector spinae plane block (ESPB), there is an alternate way to control postoperative pain and reduce opioid consumption following thoracic surgery. Further exploration of the use of the ESPB is needed to aid in practice change recommendations.

Objectives: The systematic review is designed to compile the most recent, high-quality randomized controlled trials (RCTs) concerning the use of the ESPB in thoracic surgery to control postoperative pain and reduce opioid consumption. This information will be presented in the form of an educational module to complete the study.

Data Sources: Investigators used CINAHL, PubMed, and EMBASE databases to answer the PICO (i.e., population, intervention, comparison, outcome) question: In adult patients undergoing surgery in the thoracic cavity (P), does use of the ESPB (I) provide adequate postoperative analgesia (C) and reduce opioid consumption (O)?

Methodology: Nine articles were included for analysis. The six RCTs and one before and after study had a total combined sample size of 481 adult patients undergoing thoracic cavity surgery. All seven studies showed that the ESPB was able to provide significant postoperative pain control. Four of the studies showed a reduction in intraoperative opioid consumption as well as postoperative. One study showed that the ESPB group had comparable pain scores and opioid requirements as the thoracic epidural (the gold standard for thoracic surgery pain control). Two meta-analyses were included, both showing the ESPB as effective pain control and reducing the opioid requirements. The results were presented as an educational module consisting of a pre-test, voice-over PowerPoint, and post-test administered to anesthesia providers.

Results: When analyzing results from the pre- and post-tests, the findings showed a statistically significant increase in knowledge. Attitudes towards alternative methods of pain management and the ESPB increases as well. More participants answered in favor of using the ESPB and opioid-sparing techniques when questioned on the post-test.

Conclusions: The results of the RCTs show that the ESPB can adequately control postoperative pain in direct comparison to other regional techniques in the thoracic cavity, including the gold standard thoracic epidural. In addition, the studies showed a significant reduction in opioid consumption. The ESPB is also easier to perform and has fewer side effects than the paravertebral block or thoracic epidural. Patients will have better outcomes by adding the ESPB to a balanced pain management routine for thoracic surgeries. Additionally, implementing an educational module provides the benefits of increased knowledge of the anesthesia provider and leads to more favorable views of opioid-sparing anesthesia and the ESPB.



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