Opioid-Sparing Anesthesia Protocol: An Educational Intervention to Improve Knowledge and Confidence Among Anesthesia Providers

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)

Charles F. Moseley II (Creator)

Institution

The University of North Carolina at Greensboro (UNCG )

Web Site: http://library.uncg.edu/

Advisor

Joshua Borders

Abstract: Background: Opioids have been a mainstay in analgesia for millennia but have numerous untoward side effects, including nausea, vomiting, excessive sedation, ileus, respiratory depression, pruritus, urinary retention, and a large potential for abuse, misuse, and physical dependency. Newer evidence also indicates increasing reports of other concerning adverse reactions such hyperalgesia, immunosuppression, infection, and increased risk of tumor recurrence. These adverse effects can increase recovery times, increase length of hospital stay, increase morbidity and mortality, and increase hospital costs. Other classes of medications can target different pain pathways in the nervous system and decrease amounts of opioids needed in the entire perioperative period. Limiting opioid use during the intraoperative phase has been shown to be beneficial to patients and improve outcomes including decreased nausea and vomiting, decreased time to extubation, comparable post-operative pain scores & opioid consumption, and decreased PACU length of stay. It can also help combat the ever growing opioid crisis in the United States.Purpose: The purpose of this project was to encourage the use of multimodal and opioid-sparing anesthesia among anesthesia providers with a goal to improve confidence and facilitate the transition of this technique so that it can become standard practice.Methods: Using the most current evidence, an opioid-sparing anesthesia protocol was developed and placed on a quick reference guide. An educational module was also created and distributed to anesthesia providers at a community hospital along with a pre-intervention survey to measure perceived self-confidence in administering opioid-sparing anesthesia. After five months of implementation, a post-intervention survey was then distributed to see if there were any significant changes.Results: Due to small sample size and high attrition rate, there was no statistically significant difference in perceived confidence level after the implementation of the protocol. As much as 76% of the pre-intervention survey sample somewhat or strongly agreed that they were confident in providing opioid-sparing anesthesia.Recommendations and Conclusion: Additional interventions to address provider confidence could be implemented such as having a best-practice advisory in the electronic medical record. Providers could be reached out to personally and be asked if they feel motivated by the opioid epidemic to incorporate opioid-sparing anesthesia into their practice and if they do not feel confident providing opioid-sparing anesthesia to determine what factors need to be addressed. Continued studies on opioid-sparing anesthesia should take place to address other factors that may motivate anesthesia providers to use opioids or opioid-sparing anesthesia. With the trends in data showing improved patient outcomes and decreased costs, opioid-sparing anesthesia may become standard of anesthesia care in the future.

Opioid-Sparing Anesthesia Protocol: An Educational Intervention to Improve Knowledge and Confidence Among Anesthesia Providers
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Created on 6/20/2024
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Additional Information

Publication

Other

Language: English

Date: 2023

Keywords

Opioid-sparing anesthesia, opioid-free anesthesia, multimodal analgesia and anesthesia, opioids, morphine, fentanyl, remifentanil, sufentanil, ketamine, dexmedetomidine, dexamethasone, NSAIDs, magnesium sulfate, lidocaine, celecoxib, ketorolac, regional anesthesia, confidence, quick-reference guide, addiction, substance-use disorder, opioid crisis

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