Date of this Version

11-29-2025

Document Type

DNP Project

Rights

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Abstract

Background: Cesarean delivery (CD) is one of the most common surgeries worldwide, with spinal anesthesia as the preferred technique due to its safety. However, its short duration often results in significant postoperative pain, impacting recovery, opioid use, and maternal-infant bonding. Current pain management rely heavily on opioids, which carry risks such as nausea, sedation, and respiratory depression. Regional techniques like quadratus lumborum (QL) and transversus abdominis plane (TAP) blocks offer opioid-sparing alternatives, but direct comparisons remain limited. This project evaluates the effectiveness of QL and TAP blocks in reducing postoperative pain and opioid consumption in women undergoing cesarean delivery.

Methods: This quality improvement project began with a literature synthesis to evaluate existing evidence on the effectiveness of QL and TAP blocks in reducing postoperative pain and opioid consumption in women undergoing cesarean delivery. The findings from this review were then used to create an online, self-paced educational module outlining the benefits, challenges, and clinical relevance of both blocks. CRNAs were recruited through email invitations and QR codes distributed in person. Participants completed pre- and post-test surveys that measured baseline understanding, block anatomy, clinical application, and willingness to adopt alternative pain strategies. Survey responses were analyzed to identify changes in knowledge and perceptions after the module.

Results: A total of twelve CRNAs participated in the project. After completing the module, participants showed improved knowledge in key areas: recognition of cesarean delivery as one of the top ten most painful surgeries increased from 33% to 92%, and correct identification of intrathecal morphine as the standard for post-cesarean pain control rose from 25% to 83%. Understanding of QL block anatomy also improved, with accurate responses increasing from 25% to 75%, and all participants identified its deeper anatomical access compared to the TAP block. Attitudes shifted as well, with willingness to recommend the QL block moving from 17% before the module to 75% after. These findings suggest that a short, self-paced educational module can improve both knowledge and clinical openness to alternative pain management strategies.

Discussion: This project showed that a self-paced module helped CRNAs strengthen their understanding of regional blocks for CD and become more open to recommending them in practice. Several limitations should be acknowledged, including the small sample size, the single-site setting, and challenges with recruitment. Email invitations led to low participation, and the absence of incentives may have discouraged engagement, especially during busy clinical weeks. Future efforts should aim for larger, multi-site studies, use alternative outreach methods, and incorporate hands-on training to build on the knowledge gained through online learning. Expanding this type of education could support wider use of multimodal, opioid-sparing strategies in obstetric anesthesia.

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