Date of this Version

2025

Document Type

DNP Project

Rights

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Abstract

Background: The United States is facing an opioid epidemic. Opioid-naive patients might become chronic opioid users after surgery. More than 60% of women receive neuraxial anesthetic procedures during labor and delivery in the United States. It has become standard the addition of opioids to local anesthetics administered in both the intrathecal space and the epidural space. The current push towards multimodal analgesia and away from heavy dependence on opioids for pain management have promoted the search for alternatives. Evidence shows that adding neuraxial magnesium sulfate as an adjuvant to neuraxial anesthesia in parturients provides benefits, including reduction of postoperative pain, decreased analgesic requirements, and prolongation of anesthesia or analgesia without additional side effects.

Methods: The databases CINAHL Plus, Medline, and EMBASE, were used to conduct the literature search from peer-reviewed journals published within the last ten years related to the proposed PICO question. A total of 13 articles were included in this quality improvement project. An evidence-based educational module was developed for anesthesia providers, and a pretest-postest design was used as an assessment tool. The pretest-posttest consisted of 9 multiple-choice questions, and one question using a Likert scale.

Results: A total of 18 CRNAs completed this study. There was an equal number of male and female providers participating in this study. Most participants were in the age range of 30-39 years old, identified as Hispanics, and had a doctorate level of education and 1-2 years of experience. More participants answered the knowledge-based questions correctly in the posttest compared to the pretest. Before receiving the educational intervention only 23% of the participants indicated that they were “most likely” or “somewhat likely” to use neuraxial magnesium sulfate in their practice when providing anesthesia or analgesia to parturients. However, after the education intervention, this number increased to 83%.

Discussion: Overall, the number of participants correctly answering questions in the posttest was higher than in the pretest; therefore, it can be assumed that the educational intervention was successful. Because of the intrinsic limitations of the pretest-posttest design, this result is only valid for this group of participants and cannot be generalized to other anesthesia providers that did not participate in this study. The 50% increase in providers indicating that they were “most likely” or “somewhat likely” to use neuraxial magnesium sulfate in their practice after receiving the educational intervention suggests that the providers in this group are willing to incorporate evidence-based practice interventions that improve patient outcomes.

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