Date of this Version

12-6-2021

Document Type

DNP Project

Abstract

Background: Opioids have long been considered the “gold standard” of pain management; however, the significant side effects associated with opioid use make opioid-sparing analgesic methods appealing for various reasons. Reducing postoperative opioid consumption without compromising pain management is an area requiring further exploration.

Objective: This study seeks to assess healthcare providers’ knowledge and confidence regarding the use of various preoperative and perioperative interventions aimed at reducing postoperative opioid consumption following non-emergent open abdominal surgeries. Based on the systematic review performed, Certified Registered Nurse Anesthetists were presented with a pre-assessment test, an educational video presentation, and a post-assessment test.

Data Sources: Investigator used Pubmed, CINAHL, and EMBASE databases to answer the PICO (i.e., population, intervention, comparison, outcome) question: In patients undergoing open, nonemergent abdominal surgeries, does the use of multimodal, opioid-sparing pain management techniques during the preoperative and perioperative period reduce postoperative opioid consumption versus non-multimodal pain management? This question became the basis for the educational module by the same name. Pre-assessment and post-assessment testing were used to measure the effects of the intervention. Statistical analysis was applied to assess the effectiveness of the educational intervention.

Study Selection: Nine articles were included in the systematic review and the findings were incorporated into the educational presentation. All found that their respective non-opioid interventions reduced postoperative opioid consumption to some degree. A majority reported secondary outcomes of reduced opioid-related side effects such as nausea and vomiting, decreased time to first meal, first ambulation, and foley removal, and increased patient satisfaction.

Results: There were nine participants in the study and survey. The pre- and post-test gauged participants’ knowledge and confidence in non-opioid analgesic methods and implementing them in practice. The average number of correct answers in the pre-test was 4.22, compared to 7.44 in the post-test. Confidence for preoperative and intra-operative interventions improved from 44.44% and 33.33% to 88.89% and 100%, respectively. With education, participants were more likely to advocate for opioid-sparing analgesic interventions to improve postoperative outcomes for patients undergoing non-emergent abdominal surgery. All participants selected more correct answers in the post-test than pre-test.

Conclusions: The evidence shows that several non-opioid analgesic interventions can reduce postoperative opioid consumption. The implementation of an educational module based on these findings led to a significant increase in providers’ knowledge and confidence of opioid-sparing analgesic methods in patients undergoing non-emergent open abdominal surgery and the benefits associated with non-opioid interventions.

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