Date of this Version

11-6-2025

Document Type

DNP Project

Rights

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Abstract

Background: Total knee arthroplasty (TKA) is a widely performed orthopedic surgery, oftenaccompanied by significant postoperative pain. Poor pain control in TKA patients is frequentlyassociated with increased opioid use, leading to opioid-related adverse drug events (ORADEs), prolonged hospital stays, and decreased patient satisfaction. In recent years, multimodal anesthesia, consisting of peripheral nerve blocks (PNBs) such as the adductor canal block (ACB), has become a cornerstone of TKA pain management. Liposomal bupivacaine (LB) and dexmedetomidine (DEX) have emerged as promising medications for use in the ACB for prolonging analgesia; however, evidence comparing their effectiveness in reducing opioid consumption is limited. This project aimed to answer the question: In adults undergoing total knee arthroplasty, would the use of liposomal bupivacaine single shot versus dexmedetomidine as an adjuvant in adductor canal block result in reduced opioid consumption?

Methods: This Quality Improvement (QI) project first utilized a literature synthesis approach to evaluate existing evidence on the efficacy of LB versus DEX in ACB for TKA patients in reducing opioid consumption postoperatively. Evidence supporting the use of LB and DEX in an ACB was then compiled into an educational module demonstrating the benefit of their use and their impact on reducing opioid consumption following TKA. Anesthesia providers were asked to watch the educational module and complete accompanying pre- and post-test anonymous surveys to demonstrate baseline and knowledge growth on this topic.

Results: A total of 15 anesthesia providers consented to participate in the QI project, with 12 completing all components. Pre-test data showed strong baseline knowledge in key areas, while post-test results revealed modest percentage increases in knowledge for 2 items: identification of the saphenous nerve as the target of ACB and the advantages of multimodal pain management strategies. Despite these improvements, several items demonstrated no change or slight declines in correct responses, primarily attributed to a 20% attrition rate. Provider attitudes toward ACB use showed a positive shift, with the those “extremely likely” to incorporate the ACB increasing from 31% to 42% post-intervention, and no participants remaining “extremely unlikely.”

Discussion: The educational module demonstrated modest yet meaningful improvements in anesthesia provider knowledge and attitudes. While pre-test data revealed a solid baseline understanding, slight post-test gains suggest the module helped reinforce key concepts, particularly the identification of the saphenous nerve as the target of ACB and the advantages of multimodal strategies over opioid-based approaches. Additionally, a slight positive shift in provider willingness to incorporate ACB into practice was observed, with fewer participants reporting reluctance after the intervention. However, limitations such as a small sample size and a 20% attrition rate likely influenced the overall results. The asynchronous, online format may have contributed to reduced engagement and follow-through, impacting post-test data reliability. Despite these challenges, the project highlights the importance of ongoing professional education for advanced practice nurses. By enhancing familiarity with opioid-sparing techniques such as ACB with LB or DEX, educational interventions can support safer, evidence-based postoperative pain management, ultimately improving patient outcomes and advancing clinical practice.

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