Impact of an Educational Workshop on Non-Opioid Analgesic Use by Certified Registered Nurse Anesthetists Caring for the Adult Patient Undergoing Elective Spinal Surgery
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Despite numerous adverse effects and an ongoing epidemic, opioids are frequently administered as first-line analgesics in adult spinal surgery and recovery. The purpose of this Doctor of Nursing Practice (DNP) project was to develop an educational workshop for Certified Registered Nurse Anesthetists (CRNAs) caring for adult patients undergoing spinal surgery at a Western New York (WNY) hospital based on a retrospective chart review of CRNA non-opioid analgesic use and CRNA perceived non-opioid analgesic use barriers. Workshop content focused non-opioid analgesics including ketamine, dexmedetomidine, magnesium, lidocaine infusion, gabapentinoids, and NSAIDs. Project aims were to increase CRNA non-opioid analgesic use and to decrease post-operative opioid requirements for adults undergoing spinal surgery. Project objectives were to 1) develop an evidence-based CRNA workshop focusing on non-opioid analgesic use in adult spine surgery; 2) complete a retrospective chart review examining CRNA non-opioid use for adult patients undergoing spinal surgery; 3) survey CRNAs on barriers to non-opioid analgesic use in adult spinal surgery prior to workshop implementation; and 4) conduct a one-month post-workshop retrospective chart review to assess CRNA use of non-opioids for adult patients undergoing spinal surgery. Lewin’s Theory of Planned Change was the theoretical framework. Results showed that CRNAs felt limited using non-opioids due to supervising anesthesiologist reluctance (68.3%) and surgeon reluctance (41.6%). CRNA’s attending the workshop administered non-opioids in a greater percentage of cases despite statistical non-significance. No significant change was noted in patient post-op pain scores or morphine requirements. Future research is needed exploring open lines of communication among interdisciplinary anesthesia teams.