Date of this Version

11-26-2025

Document Type

DNP Project

Abstract

Background: Cardiac surgery involves significant postoperative pain, regardless of the surgical technique used. Poorly controlled pain following sternotomy in cardiac surgery will lead to a series of adverse outcomes, hindering the patient’s recovery process and extending the hospital stay. The failure to adopt an effective pain management protocol for invasive cardiac surgery can impede patients’ ability to return to a functional baseline and increase the risk of reliance on rescue analgesia, perhaps leading to opioid dependence. Intravenous opiates alone or in combination with other analgesics do not provide a complete solution to this issue. Regional techniques, such as ultrasound-guided Erector Spinae Plane blocks and parasternal blocks, may serve as a valuable solution for optimizing the postoperative pain experience in cardiac surgical patients. Evidence suggests superior efficacy of implementing these fascial plane regional blocks for patients undergoing invasive cardiac surgery to optimize postoperative pain management and reduce opioid consumption, ultimately enhancing recovery. Regional anesthesia for pain management aligns seamlessly with the enhanced recovery after surgery (ERAS) protocol, which can serve as a fundamental component of the standards of care for patients undergoing cardiac surgery.

Objectives: This quality improvement project aimed to enhance anaesthesia providers’ knowledge of the benefits of implementing effective regional fascial plane block techniques to establish an optimal pain management plan for patients undergoing cardiac surgery.

Methods: The principal approach for this quality improvement initiative involved delivering an educational module to anaesthesia practitioners, equipping them with knowledge and research regarding the advantages of incorporating ESP and parasternal regional blocks into the anaesthesia pain management plan to improve recovery outcomes in patients undergoing cardiac surgery. A pre- and post-assessment survey was employed to evaluate the efficacy of this educational intervention. This project was launched at a level 1 trauma center and disseminated online to anonymous respondents in the form of a survey.

Results: The survey revealed superior knowledge enhancement of anesthesia providers in ESP and parasternal regional techniques used for optimizing postoperative pain in patients undergoing open cardiac surgery. Participants demonstrated a 60% improvement in recognizing safety and an absence of hematoma formation when using these techniques in cardiac surgery, as well as a 60% increase in their readiness to incorporate these regional modalities into practice.

Conclusion: The findings of this quality improvement project positively impacted anesthesia providers by enhancing their knowledge and confidence in employing regional anesthesia for cardiac surgical patients. This could improve patient outcomes and lower hospital costs by reducing opioid consumption, length of stay, and postoperative complications.

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