Date of this Version

11-21-2025

Document Type

DNP Project

Rights

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Abstract

Background: Post-cesarean section pain, a major abdominal surgery, remains a challenge because pain must be pharmacologically managed while having a minimal impact on the neonate. With an increase in neonates born via a surgical procedure, the importance of effective pain management after surgery is of utmost importance. Mismanagement of pain in the elective cesarean section (CS) mother leads to an inability to care for the newborn, increased incidence of post-partum depression, and chronic pain syndromes. Currently, opioid use and spinal anesthesia are standard practices. However, spinal anesthesia alone is not sufficient to provide post-cesarean-section pain control. Opioid use can lead to detrimental effects on the neonate, decreased mobility, and the inability to care for the neonate, and contributes to the opioid crisis in the United States. Transversus Abdominis Plane (TAP) blocks are used in major abdominal surgeries; however, the current literature suggests that Erector Spinae Plane (ESP) blocks have a greater pain efficacy and safety profile. An ESP block provides longer pain relief, reduces post-operative opioid consumption, and improves recovery and ambulation in the CS patient.

Method: This quality improvement (QI) project aimed to increase certified registered nurse anesthesia (CRNAs) providers' knowledge of current literature on an ESP versus a TAP block for improved post-operative recovery in elective CS patients. A sample size of 10 CRNAs from a large independent teaching hospital participated. A 10-question pre-test survey was administered to assess for baseline knowledge on the subject. A 10-minute voice-over educational module, presented in the form of a PowerPoint (PPT), highlighted current research and data. A 10-question post-test was administered to assess knowledge and understanding gained from the provided material. Data was collected via Qualtrics and organized to reflect descriptive statistics, data measuring knowledge, and the likelihood of incorporating new research into clinical practice. The QI project adhered to ethical standards and obtained approval from the Institutional Review Board (IRB), ensuring that informed consent was obtained and participation was voluntary. All identifiable information collected from participants remained confidential and anonymous.

Result: The educational PPT increased anesthesia provider knowledge on the benefits of an ESP block for pain management and improved outcomes in the patient undergoing a CS, and their willingness to incorporate an ESP block in clinical practice. The administered pre-test reflected limited knowledge, with only 30% (n=3) of providers understanding the analgesic efficacy of an ESP block. The post-test showed a marked increase in provider knowledge of 60% (n=6) of providers having an increased knowledge gain, a 50% increase. The willingness to implement an ESP block into clinical practice increased from 70% (n=7) to 90% (n=9). An increased knowledge and positive attitude towards the use of an ESP block in the clinical setting showcases the impact of the educational module on CRNAs.

Discussion: Overall, the QI project enhanced provider knowledge and understanding of the mechanisms of an ESP block. Although the sample size was small, the intervention resulted in a significant increase in knowledge and willingness to incorporate into the clinical setting. The QI project highlights the need for further research to establish an ESP block as a common practice and to optimize alternatives to pain management. Challenges such as accessibility of online material, and impersonal delivery of the educational module are areas for improvement in the study design.

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