Date of this Version

11-2-2025

Document Type

DNP Project

Rights

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Abstract

Background: Thoracic surgeries, especially those involving thoracotomy, are known for the severity and duration of post-operative pain. Minimizing complications and optimizing pulmonary function are highly dependent on effective pain management. Additionally, these patients are at a high risk of post-operative thoracic syndrome. Current approaches include thoracic epidural, patient-controlled opioid administration, and non-opioid analgesia. However, thoracic epidural has contraindications including hypotension and low platelet counts and opioid administration decreases respiratory drive, which increases the risk for pulmonary complications. The purpose of this quality improvement project was to increase knowledge in anesthesia providers using an educational module about how the use of cryoanalgesia in thoracic surgeries can provide effective pain management, reduce opioid use, and decrease pulmonary complications.

Methods: A literature review was conducted using PubMed, Cochrane Review, and Embase databases. The search strategy included key terms “cryoanalgesia,” “thoracic epidural,” “thoracic surgery,” and “pain.” Eleven articles were included for review. The Institutional Review Board (IRB) approval 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 cryoanalgesia as a pain management technique for patients undergoing thoracic surgery 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: This quality improvement project had 14 participants (n= 14) who agreed and consented to participate in an instructional educational module. After completing the educational module, the providers demonstrated an increased knowledge of Intercostal cryoanalgesia (CRYO) with a higher likelihood of advocating for its use in pain management following thoracic surgery. This was demonstrated by an increase in correct responses regarding the advantages of CRYO and its implication on post-operative respiratory outcomes. The findings showed a significant increase in certified nurse anesthetists’ (CRNAs’) understanding of CRYO and strategies to reduce post-thoracic surgery complications.

Discussion: The focus of this educational module was formulated to assess and enhance CRNA knowledge of intercostal cryoanalgesia (CRYO) as an adjunct pain management technique in thoracic surgery. After completing the educational module, providers showed an increase in knowledge regarding CRYO, its benefits, and populations that stand to benefit the most for its implementation. The main limitation for this study include a small sample size (n = 14) and high attrition rate (28.5%). The educational module was shown to be beneficial in educating CRNAs and enhancing knowledge and subsequently shift providers attitudes toward CRYO.

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